Hyperkalemia is associated with an elevated risk of death in the general population, investigators reported online ahead of print in Mayo Clinic Proceedings.

A team led by Morgan E. Grams, MD, PhD, of Johns Hopkins Bloomberg School of Public Health in Baltimore, studied 15,539 adult participants in the Atherosclerosis Risk in Communities (ARIC) Study, a prospective epidemiologic study conducted in 4 US communities. At baseline, 321 (2.1%) patients had hyperkalemia and 413 (2.7%) had hypokalemia. 

In a fully adjusted model, hyperkalemia (serum potassium 5.5 mmol/L or higher) was associated with a significant 24% increased risk of death compared with normokalemia (, but not sudden cardiac death, chronic kidney disease (CKD), or end-stage renal disease (ESRD). Hypokalemia (serum potassium below 3.5 mmol/L) was associated with all-cause mortality and kidney outcomes in participants not taking potassium-wasting diuretics. In this group, hypokalemia was associated with a significant 74% increased risk of mortality, 65% increased risk of CKD, and 2.6-fold increased risk of ESRD compared with normokalemia.

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“Although our study suggests that both hypokalemia and hyperkalemia may lead to adverse outcomes, our data are observational and cannot demonstrate causality,” Dr Grams’ group wrote. “If abnormal potassium itself causes adverse outcomes—a plausible scenario, particularly for the development of arrhythmias—then clinical treatment may be beneficial. Indeed, correction of abnormal values of potassium is often prescribed, by supplementation, changes in diet, or potassium-altering medications.”

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