Occurrence, recurrence, and prognosis of hyperkalaemia in a large real-world cohort

Abstract

Abstract Background Hyperkalaemia (HK), a common electrolyte abnormality, often occurs in patients with other comorbidities. This study assessed the occurrence, recurrence, and prognosis of HK in a real-world setting. Methods In this single-center, retrospective study (January 2018–December 2021), patients aged ≥ 18 years who had serum potassium (sK+) > 5.0 mmol/L at least once and who visited Ren Ji Hospital were analyzed for prevalence, recurrence and real-world cumulative survival. Results Of 55 288 patients screened, 1 141 (2.1%) had HK. Overall, 1 131 (2.0%) patients were enrolled with a mean age of 68 ± 16.7 years, the majority being men (57.6%), and with median sK+ levels of 5.40 (5.2–5.8) mmol/L; most patients had mild HK (62.6%). The cumulative 1-year survival rate was 81.5%. Recurrence of HK occurred in 25.8% of patients, with a median (interquartile range) time of 35 (7–192) days. The time to first re-examination was < 7 days in 55.1%, <30 days in 61.1%, <90 days in 63.7%, and > 90 days in 4.9%. Hypertension (49.4%) was the most common comorbidity, followed by diabetes, coronary artery disease, and malignancy. High usage of β-blockers (17.6%), followed by ACEIs/ARB, aldosterone receptor antagonists, and non-steroidal anti-inflammatory drugs, was observed. All-cause mortality was 20.2%, significantly higher in moderate-to-severe HK compared with mild HK. Risk factors associated with all-cause mortality included sK+ levels (per 1 mmol/L increase) (hazard ratio [HR]: 1.328) and anemia (HR: 2.027). Conclusions HK is common among real-world patients in a large tertiary centre in China, with high recurrence rates and poor clinical prognosis. As a substantial proportion of patients did not undergo repeat sK⁺ measurement, the recurrence rate reported here likely underestimates the true real-world burden of recurrent HK.