De novo hyperkalemia is an independent risk factor for death, cardiovascular events, hospitalizations, and intensive care unit (ICU) admissions, a new study confirms.

Using administrative databases from Manitoba, Canada, investigators studied 93,667 patients with de novo hyperkalemia, defined as a serum potassium of 5.0 mmol/L or higher. Among patients who experienced hyperkalemia, 36% had diabetes mellitus, 28% had nondialysis chronic kidney disease (CKD), and 21% had heart failure.

In a propensity-matched cohort in which 88,541 patients with de novo hyperkalemia were matched to 88,541 patients without a hyperkalemic episode, de novo hyperkalemia was associated with a significant 15% increased risk for all-cause mortality, Navdeep Tangri, MD, PhD, of Seven Oaks General Hospital in Winnipeg, Manitoba, Canada, and colleagues reported in Kidney International Reports. It also correlated with a significant 20% increased risk of being hospitalized for a cardiovascular event, including atrial fibrillation, heart failure, ischemic heart disease, myocardial infarction, peripheral vascular disease, stroke, or unstable angina.

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In addition, de novo hyperkalemia was associated with significant 1.7- and 3.5-fold increased odds for hospitalization and ICU admissions, respectively, and 29% increased odds of dying within 30 days, the investigators reported. None of the findings changed when the researchers used a higher serum potassium threshold of 5.5 mmol/L or more to define hyperkalemia.

A total of 36.0% of patients had hyperkalemia recurrence during the study period from January 2007 to March 2017.

The study results confirm the conclusions of other large, observational studies and adds novel information on ICU admissions and long-term mortality. “Taken together, these findings suggest that a single episode of hyperkalemia is associated with a major disease burden that extends well beyond the acute episode, and that elevated potassium levels may contribute to increased health care costs in both the short term and the long term,” Dr Tangri’s team wrote.


Hougen I, Leon SJ, Whitlock R, et al. Hyperkalemia and its association with mortality, cardiovascular events, hospitalizations, and intensive care unit admissions in a population-based Q1 retrospective cohort. KI Reps. Published online March 16, 2021. doi:10.1016/j.ekir.2021.02.038