Emergency department hyperkalemia in the hemodialysis (HD) population can be predicted and modified, investigators suggested at the American Society of Nephrology’s Kidney Week 2021.

According to an emergency services database, 270 patients on HD had 877 ambulance transports to the emergency department. The median serum potassium at presentation was 4.6 mmol/L. However, 11% of transports involved severe hyperkalemia, defined as a serum potassium level of 6 mmol/L or higher.

In a model, prehospital electrocardiogram (ECG) abnormalities, including peaked T-waves or first-degree atrioventricular block, were significantly associated with 6.6-fold increased odds of severe hyperkalemia, Karthik K. Tennankore, MD, of Dalhousie University in Halifax, Nova Scotia, Canada, and colleagues reported. The investigators suggested that prehospital ECG may be underutilized since it was performed in only 35% of visits involving hyperkalemia.

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Compared with a normal heart rate, bradycardia of less than 60 beats per minutes was significantly associated with 2.0-fold odds of severe hyperkalemia in a fully adjusted model, they reported.

For each year on dialysis, the odds of severe hyperkalemia significantly increased 21%. As the days from the last dialysis session increased from 1 to 2 to 3 or more, the odds of severe hyperkalemia significantly increased 8.0-, 31.3-, and 49.8-fold, respectively.

A total of 423 patients with potassium elevations (60%) — including 40 patients (10%) with severe hyperkalemia — were sent to a center that could not perform dialysis. Of the severe cases, 17 (43%) required re-transport to a facility capable of providing emergent dialysis.

“Having an awareness of these associations may allow healthcare providers to define novel care pathways to ensure timely diagnosis and management of hyperkalemia,” Dr Tennankore’s team stated.

They encouraged point of care testing and treatment and efforts to ensure timely transport to appropriate dialysis facilities.

This research was supported by Otsuka. Please see the original reference for a full list of disclosures.


Tennankore KK, Clark D, Fok PT, et al. Predictors of hyperkalemia among chronic hemodialysis patients transported to the emergency department. Presented at: Kidney Week 2021, November 2-7, 2021. Poster PO0887.