Patients with diabetes, chronic kidney disease (CKD), and a history of major adverse cardiovascular events (MACE) have higher rates of hyperkalemia and death than patients with diabetes alone, according to a poster presentation at the American Society of Nephrology’s Kidney Week 2020 Reimagined virtual conference.

Using the UK Clinical Practice Research Datalink GOLD database, investigators identified 288,871 patients with type 1 or 2 diabetes mellitus, of whom 63,078 had co-existing CKD, 47,648 a history of MACE, and 33,358 both CKD and MACE (comprising arrhythmia, heart failure, myocardial infarction, and stroke).

The highest adjusted incidence rate (per 1000 patient-years) of hyperkalemia of 5.0 mmol/L or greater was found among patients with diabetes plus CKD and MACE: 779.3 compared with 635.3 plus CKD without MACE, 384.1 withMACE but no CKD, and 246.8 with neither CKD nor MACE, Philip McEwan, PhD, of Health Economics and Outcomes Research Ltd in Cardiff, United Kingdom, and colleagues reported. A similar pattern was observed at serum potassium thresholds of 5.5 and 6.0 mmol/L or higher.

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Patients with CKD and/or MACE were more likely than those free of these complications to be taking renin angiotensin aldosterone system (RAAS) inhibitors: 74.9% to 76.3% vs 61.9% diabetes alone, the investigators reported. Routine monitoring of serum potassium in patients with diabetes mellitus and CKD and/or MACE may better identify those at risk for adverse clinical outcomes, according to Dr McEwan’s team. 

With respect to all-cause mortality, the investigators found that incidence rates increased along with comorbidity burden, rising from 12 per 1000 person-years for patients with diabetes and neither CKD nor MACE to 146.7 per 1000 person-years for patients with diabetes plus MACE and CKD.

Disclosure: This clinical trial was supported by AstraZeneca. Please see the original reference for a full list of authors’ disclosures.


McEwan P, Hurst MA, Hoskin L, et al. Hyperkalaemia risk and mortality in patients with diabetes. Presented at: Kidney Week 2020 Reimagined, October 19-25, 2020. Poster PO0968.