Table 3.
HK severity – baseline characteristics and post-index outcomes
| Mild HK n = 131,509 (81%) | Moderate HK n = 25,380 (16%) |
Severe HK n = 4,960 (3%) |
P-value | ||
|---|---|---|---|---|---|
| Mean age (years) | 60 ± 18 | 60 ± 19 | 58 ± 19 | < 0.0001 | |
| Age categories | < 0.0001 | ||||
| < 65 years | 56% | 55% | 59% | ||
| 65–74 years | 20% | 19% | 18% | ||
| ≥ 75 years | 24% | 26% | 23% | ||
| Sex (male) | 51% | 50% | 48% | < 0.0001 | |
| CCI | 3.2 ± 2.7 | 3.9 ± 2.9 | 4.1 ± 3.0 | < 0.0001a | |
| Mean baseline sK (mmol/L)b | 5.2 ± 0.1 | 5.8 ± 0.2 | 7.3 ± 1.1 | < 0.0001 | |
| Traditional CV Risk Factors | |||||
| Hypertension | 62% | 65% | 65% | < 0.0001 | |
| Hyperlipidaemia | 56% | 51% | 47% | < 0.0001 | |
| Diabetes | 32% | 36% | 37% | < 0.0001 | |
| Smoking | 25% | 29% | 33% | < 0.0001 | |
| Renal insufficiency | 14% | 24% | 38% | < 0.0001 | |
| BMI categories (kg/m2) | < 0.0001 | ||||
| < 25 | 29% | 31% | 30% | ||
| 25–29.9 | 31% | 29% | 30% | ||
| ≥ 30 | 40% | 40% | 40% | ||
| Maximum SBP (mm Hg) | 162 ± 77 | 166 ± 59 | 166 ± 52 | < 0.0001 | |
| EF (%) | 38 ± 13 | 57 ± 14 | 58 ± 13 | < 0.0001 | |
| Prior Diagnosis | |||||
| ASCVD | 20% | 22% | 19% | < 0.0001 | |
| CAD | 7% | 8% | 7% | < 0.0001 | |
| MI | 3% | 4% | 3% | < 0.0001 | |
| Stroke | 1% | 2% | 2% | < 0.0001 | |
| TIA | 4% | 4% | 3% | 0.001 | |
| PVD | 1% | 1% | 0.9% | < 0.0001 | |
| Heart failure | 18% | 24% | 26% | < 0.0001 | |
| Atrial fibrillation | 13% | 16% | 17% | < 0.0001 | |
| Baseline Medications | |||||
| Statin | 40% | 37% | 33% | < 0.0001 | |
| Other anti-diabetic | 10% | 10% | 9% | 0.55 | |
| Insulin | 23% | 29% | 31% | < 0.0001 | |
| Metformin | 18% | 17% | 16% | 0.01 | |
| Sulfonylurea | 11% | 12% | 10% | < 0.0001 | |
| NSAID | 63% | 61% | 60% | < 0.0001 | |
| ACEi | 38% | 39% | 36% | < 0.0001 | |
| ARB | 16% | 16% | 15% | 0.10 | |
| Aldosterone inhibitor | 6% | 8% | 9% | < 0.0001 | |
| Beta-blocker | 31% | 34% | 32% | < 0.0001 | |
| Diuretic | 41% | 46% | 45% | < 0.0001 | |
| CCB | 21% | 24% | 23% | < 0.0001 | |
| Furosemide | 23% | 29% | 30% | < 0.0001 | |
| Torsemide | 1% | 2% | 1% | < 0.0001 | |
| SPS | 0.3% | 0.8% | 0.8% | < 0.0001 | |
| Patiromer | 0% | 0% | 0% | – | |
| 3-Year Post-Index Outcomes (n = 145,173) | |||||
| n = 117,902 | n = 22,879 | n = 4392 | |||
| MACEc | 17.2% | 25.1% | 27.9% | < 0.0001 | |
| Death | 15.2% | 22.7% | 25.9% | < 0.0001 | |
| MI | 0.2% | 0.2% | 0.2% | 0.79 | |
| Stroke | 0.9% | 1% | 0.7% | 0.06 | |
| HFH | 2.6% | 3.6% | 3.3% | < 0.0001 | |
| Multivariable Hazard Ratio (95% CI) for 3-Year MACEc | |||||
| Moderate vs mild HK | 1.29 (1.25, 1.33), P < 0.0001 | ||||
| Severe vs mild HK | 1.31 (1.23, 1.40), P < 0.0001 | ||||
| Post-Index Annualized Acute Care Trends | |||||
| ED | |||||
| Mean cost ± SD | $519 ± 7,819 | $701 ± 6,936 | $668 ± 2,100 | < 0.0001a | |
| Median (IQR) | 54 (0, 391) | 67 (0, 477) | 68 (0, 554) | ||
| 1-year visit (primary diagnosis) | 0.1% | 0.4% | 0.7% | < 0.0001a | |
| Inpatient | |||||
| Mean cost ± SD | $9,626 ± 73,418 | $16,328 ± 155,262 | $18,743 ± 125,932 | < 0.0001a | |
| Median (IQR) | 0 (0, 4235) | 0 (0, 6222) | 788 (0, 7332) | ||
| 1-year visit (primary diagnosis) | 0.1% | 0.4% | 1.1% | < 0.0001a | |
ACEi Angiotensin-converting enzyme inhibitor, ARB Angiotensin-II receptor blockers, ASCVD Atherosclerotic cardiovascular disease, BMI Body mass index, CAD Coronary artery disease, CCB Calcium channel Blocker, CCI Charlson Comorbidity Index, CV Cardiovascular, ED Emergency department, EF Ejection fraction, HFH Heart failure hospitalization, HK Hyperkalaemia, IQR Interquartile range, MACE Major adverse CV event, MI Myocardial infarction, NSAID Nonsteroidal anti-inflammatory drug, PVD Peripheral vascular disease, SBP Systolic blood pressure, SD Standard deviation, sK Serum potassium, SPS Sodium polystyrene sulfonate, TIA Transient ischaemic attack
Models adjusted by baseline characteristics, risk factors, and medications
aThe non-parametric Mann–Whitney rank sum test was utilized to determine P-value
bTaken within ± 1 month of index date (baseline sK level)
cMACE is the composite of death, MI, stroke, and HFH