Hyperkalemia and severe hypokalemia commonly ensue from acute kidney injury (AKI), even outside of the intensive care setting, Swiss investigators concluded.

Of 20,421 patients who made emergency department visits, 1692 (8.3%) met criteria for AKI, including 982 (58%) patients with AKI Network (AKIN) stage 1, 445 (26%) with stage 2, and 265 (16%) with stage 3 based on measured or estimated creatinine. A total of 197 patients had acute on chronic kidney disease (CKD).

Clinicians identified hyperkalemia (potassium level greater than 5.0 mmol/L) in 13% and hypokalemia (potassium level less than 3.5 mmol/L) in 11% of patients with AKI, Gregor Lindner, MD, of Solothurn City Hospital in Solothurn, Switzerland, and colleagues reported in The International Journal of Clinical Practice. Hyperkalemia was significantly more common in patients with than without AKI or acute on chronic kidney injury (P <.001). Having either high or very low serum potassium was associated with a prolonged hospital stay compared with having normal potassium levels: 7 vs 2 days for serum potassium less than 2.5 or more than 6 mmol/L and 4 vs 2 days for serum potassium levels of 5.1 to 6 mmol/L. Compared with normokalemia, potassium levels of 5.0 to 6.0 and greater than 6 mmol/L were significantly associated with 1.7- to 2.8-fold increased odds of in-hospital mortality (P =.021 and P = .015, respectively); severe hypokalemia (potassium level below 2.5 mmol/L) wassignificantly associated with 3.9-fold greater odds for in-hospital mortality (P =.015).

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In a binary regression analysis, AKIN stage, preexisting CKD, and use of potassium-sparing diuretics or angiotensin-converting enzyme inhibitors were the strongest risk factors for hyperkalemia (all P <.0001). Use of loop or thiazide diuretics and medical reason for admission were significantly associated with greater risks for hypokalemia (all P <.001).

“Dyskalemias are common in emergency patients with AKI and are independent risk factors for adverse outcomes,” Dr Lindner’s team concluded.


Ravioli S, Pluess E, Funk GC, et al. Dyskalemias in patients with acute kidney injury presenting to the emergency department are common and independent predictors of adverse outcome. Int J Clin Pract. Published online August 8, 2020. doi:10.1111/ijcp.13653