Hyperkalemia recurrence is more likely in patients who are older, male, Hispanic, or Black, according to new data presented at the American Society of Nephrology’s Kidney Week 2021.

Investigators analyzed a cohort of 2,457,498 US veterans who had an initial hyperkalemia episode, defined as serum potassium exceeding 5.0 mEq/L, from 2004 to 2018. The mean potassium level was 5.31 mEq/L, and median estimated glomerular filtration rate (eGFR) was 68 mL/min/1.73 m2 at the first episode. Mean age of the cohort was 63 years, 96% of patients were male, 13% were Black, and 6% were Hispanic.

Recurrent hyperkalemia within 1 year after the index hyperkalemia event occurred in 376,358 patients (15.3%), Elani Streja, MPH, PhD, of the VA Long Beach Healthcare System in Long Beach, California, Kam Kalantar-Zadeh, MD, MPH, PhD, of the University of California Irvine, and Yasmin Brahmbhatt, MD, of AstraZeneca, reported on behalf of their team.

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Black patients had a significant 19% higher risk of recurrence within 1 year compared with White patients. Hispanic patients had a significant 34% higher risk of recurrence compared with non-Hispanic patients.

The investigators discussed these racial differences in an interview with Renal & Urology News. Health care disparities, differences in potassium physiology, and dietary challenges are among the many possible contributors, they said.

“Further studies are needed to understand the reasons for differences in hyperkalemia recurrence between races and ethnicities and the possible implications for clinical management,” they said. 

In this study, men had a 22% higher risk of recurrence compared with women. For each 15 year increment in age, the risk for recurrent hyperkalemia increased 15%.

At-risk patients warrant closer monitoring and a personalized treatment plan, according to the investigators. Ensuring patient compliance with treatment remains key.

“Patients need to follow their treatment plan carefully if they have diabetes, kidney disease, heart disease, or any other serious chronic condition to help keep potassium levels in the healthy range. Hyperkalemia management may include diuretics, potassium binders, and dietary potassium restriction,” according to the investigators.

Disclosure: This research was supported by AstraZeneca. Please see the original reference for a full list of disclosures.


Streja E, Hsiung, JT, Agiro A, Brahmbhatt YG, Cooper K, Kalantar-Zadeh K. Racial and ethnic predictors of hyperkalemia recurrence. Presented at: Kidney Week 2021; November 2-7, 2021. Poster PO2329.