Outpatient dyskalemias are associated with increased risks of hospital and emergency department (ED) visits in patients with advanced chronic kidney disease (CKD), a new study confirms.

Investigators identified 21,366 US veterans (98% male) with an estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2. Among 125,266 outpatient serum potassium measurements from these patients, 6.8% and 3.7% met criteria for hyperkalemia (more than 5.5 mEq/L) and hypokalemia (less than 3.5 mEq/L), respectively.

In a multivariable-adjusted model, hyperkalemia and hypokalemia episodes were significantly associated with 2.0- and 1.7-fold increased odds of hospital visits within 2 days, respectively, compared with normal serum potassium, Csaba P Kovesdy, MD, of the Memphis VA Medical Center in Memphis, Tennessee, and colleagues reported in the Journal of Managed Care and Specialty Pharmacy. Hyperkalemia and hypokalemia were significantly associated with 1.4- and 1.5-fold increased odds of hospital visits due to “diseases of the circulatory system” and 4.5- and 2.4-fold increased odds of hospital visits due to “endocrine, nutritional, and metabolic diseases and immunity disorders” (including 11.9- and 4.4-fold increased odds visits due to “fluid and electrolyte disturbances”), respectively. But the investigators urged caution in interpreting these results due to the low event rates in these subgroups.

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Compared with normal serum potassium levels, hyperkalemia and hypokalemia were also significantly associated with 1.8- and 1.2-fold increased odds of ED visits within 2 days, respectively, Dr Kovesdy and his peers reported. Serum potassium values less than 3.5 mEq/L and 6.0 mEq/L or higher were associated with higher 1.2- and 3.0-fold increased odds of ED visits, respectively.

Patients with advanced CKD have high rates of comorbidities such as hypertension and cardiovascular disease and medication use (eg, renin-angiotensin-aldosterone system inhibitors and diuretics) that can affect serum potassium levels in the setting of declining kidney function. Dyskalemias can induce arrhythmias and lead to sudden cardiac death.

Close monitoring of potassium levels and potassium-binding agents, such as patiromer calcium and sodium zirconium cyclosilicate, for hyperkalemia might help reduce health care utilization and economic burden, according to Dr Kovesdy’s team.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Dashputre AA, Gatwood J, Sumida K, et al. Association of dyskalemias with short-term health care utilization in patients with advanced CKD. J Manag Care Spec Pharm. 27(10):1403-1415. doi:10.18553/jmcp.2021.27.10.1403