Among solid organ transplant recipients, hyperkalemia risk may be highest in those receiving a kidney, according to new study findings presented at the National Kidney Foundation’s 2022 Spring Clinical Meetings in Boston, Massachusetts.

Among 199 solid organ transplants (55 kidney, 74 liver, and 70 heart) performed at Westchester Medical Center in Valhalla, New York, from 2018 to 2021, hyperkalemia (serum potassium greater than 5 mEq/L) only occurred in 12% in the first year of transplant, Isaac Pak, DO, and colleagues reported in a poster presentation. Kidney transplant recipients had the highest incidence of hyperkalemia at 1 month after transplant (18.2%). Severe hyperkalemia (serum potassium greater than 5.5 mEq/L) occurred in 7.2% of kidney transplant recipients on the day of transplant surgery.

Heart and liver transplant recipients had significantly lower risks (less than 5%) for any and severe hyperkalemia compared with kidney transplant recipients, especially during the first month.

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“The relatively high incidence of hyperkalemia seen within 1 month of kidney transplant that eventually decreases to levels closer to other organ transplants at 3 months and 1 year suggests underlying renal dysfunction is the cause of hyperkalemia within this timeframe, rather than commonly used post-transplant medications,” Dr Pak’s team concluded.

The investigators noted that in the long-term, medications such as prophylactic antibiotics and anti-rejection medications may contribute to increased risk of hyperkalemia.


Pak I, Fullmer J, Kore S, Chugh S. Hyperkalemia in solid organ transplantation. Presented at the National Kidney Foundation’s 2022 Spring Clinical Meetings, Boston, Massachusetts, April 6-10, 2022. Poster 414.