Initial and Recurrent Hyperkalemia Events in Patients With CKD in Older Adults: A Population-Based Cohort Study
| Title: | Initial and Recurrent Hyperkalemia Events in Patients With CKD in Older Adults: A Population-Based Cohort Study |
|---|---|
| Authors: | Sriram Sriperumbuduri, Eric McArthur, Gregory L. Hundemer, Mark Canney, Navdeep Tangri, Silvia J. Leon, Sara Bota, Ann Bugeja, Ayub Akbari, Greg Knoll, Manish M. Sood |
| Source: | Canadian Journal of Kidney Health and Disease, Vol 8 (2021) |
| Publisher Information: | SAGE Publishing, 2021. |
| Publication Year: | 2021 |
| Collection: | LCC:Diseases of the genitourinary system. Urology |
| Subject Terms: | Diseases of the genitourinary system. Urology, RC870-923 |
| More Details: | Background: The risk of hyperkalemia is elevated in chronic kidney disease (CKD); however, the initial and recurrent risk among older individuals is less clear. Objectives: We set out to examine the initial and 1-year recurrent risk of hyperkalemia by level of kidney function (estimated glomerular filtration rate, eGFR) in older adults (≥66 years old). Design: Population-based, retrospective cohort study Settings: Ontario, Canada Participants: 905 167 individuals (≥66 years old) from 2008 to 2015. Measurements: Serum potassium values Methods: Individuals were stratified by eGFR (≥90, 60-89, 30-59, 15-29 mL/min/1.73 m 2 ) and examined for the risk of incident hyperkalemia (K ≥ 5.5 mEq/L) using adjusted Cox proportional hazards models. The 1-year risk of recurrent hyperkalemia was examined using multivariable Andersen-Gill models. Results: Among a population of 905 167 individuals (15% eGFR ≥ 90, 58% eGFR 60-89, 25% eGFR 30-59, 3% eGFR 15-29) with a potassium measurement, there were a total of 18 979 (2.1%) individuals with hyperkalemia identified. The event rate (per 1000 person-years) and adjusted hazard ratio (HR) of hyperkalemia was inversely associated with eGFR (mL/min; eGFR >90 mL/min: 8.8, referent, 60-89 mL/min: 11.8 HR 1.41; eGFR 30-59: 39.8, HR 4.37; eGFR 15-29: 133.6, 13.65) and with an increasing urine albumin-to-creatinine ratio (ACR, mg/mmol; ACR< 3: 14, referent, ACR 3-30: 35.1, HR 1.98; ACR >30: 93.7, 4.71). The 1-year event rate and adjusted risk of recurrent hyperkalemia was similarly inversely associated with eGFR (eGFR ≥ 90: 10.1, referent, eGFR 60-89: 14.4, HR 1.47; eGFR 30-59: 54.8, HR 4.90; eGFR 15-29: 208.0, HR 12.98). Among individuals with a baseline eGFR of 30 to 59 and 15 to 29, 0.9 and 3.8% had greater than 2 hyperkalemia events. The relative risk of initial and recurrent hyperkalemia was marginally higher with RAAS blockade. Roughly 1 in 4 individuals with hyperkalemia required hospitalization the day of or within 30 days after their hyperkalemia event. Limitations: Limited to individuals aged 66 years and above. Conclusions: Patients with low eGFR are at a high risk of initial and recurrent hyperkalemia. Trial registration: N/A |
| Document Type: | article |
| File Description: | electronic resource |
| Language: | English |
| ISSN: | 2054-3581 20543581 |
| Relation: | https://doaj.org/toc/2054-3581 |
| DOI: | 10.1177/20543581211017408 |
| Access URL: | https://doaj.org/article/1ff8ebf06d0d42fc96afdd96f5e9de62 |
| Accession Number: | edsdoj.1ff8ebf06d0d42fc96afdd96f5e9de62 |
| Database: | Directory of Open Access Journals |
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| Items | – Name: Title Label: Title Group: Ti Data: Initial and Recurrent Hyperkalemia Events in Patients With CKD in Older Adults: A Population-Based Cohort Study – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Sriram+Sriperumbuduri%22">Sriram Sriperumbuduri</searchLink><br /><searchLink fieldCode="AR" term="%22Eric+McArthur%22">Eric McArthur</searchLink><br /><searchLink fieldCode="AR" term="%22Gregory+L%2E+Hundemer%22">Gregory L. Hundemer</searchLink><br /><searchLink fieldCode="AR" term="%22Mark+Canney%22">Mark Canney</searchLink><br /><searchLink fieldCode="AR" term="%22Navdeep+Tangri%22">Navdeep Tangri</searchLink><br /><searchLink fieldCode="AR" term="%22Silvia+J%2E+Leon%22">Silvia J. Leon</searchLink><br /><searchLink fieldCode="AR" term="%22Sara+Bota%22">Sara Bota</searchLink><br /><searchLink fieldCode="AR" term="%22Ann+Bugeja%22">Ann Bugeja</searchLink><br /><searchLink fieldCode="AR" term="%22Ayub+Akbari%22">Ayub Akbari</searchLink><br /><searchLink fieldCode="AR" term="%22Greg+Knoll%22">Greg Knoll</searchLink><br /><searchLink fieldCode="AR" term="%22Manish+M%2E+Sood%22">Manish M. Sood</searchLink> – Name: TitleSource Label: Source Group: Src Data: Canadian Journal of Kidney Health and Disease, Vol 8 (2021) – Name: Publisher Label: Publisher Information Group: PubInfo Data: SAGE Publishing, 2021. – Name: DatePubCY Label: Publication Year Group: Date Data: 2021 – Name: Subset Label: Collection Group: HoldingsInfo Data: LCC:Diseases of the genitourinary system. Urology – Name: Subject Label: Subject Terms Group: Su Data: <searchLink fieldCode="DE" term="%22Diseases+of+the+genitourinary+system%2E+Urology%22">Diseases of the genitourinary system. Urology</searchLink><br /><searchLink fieldCode="DE" term="%22RC870-923%22">RC870-923</searchLink> – Name: Abstract Label: Description Group: Ab Data: Background: The risk of hyperkalemia is elevated in chronic kidney disease (CKD); however, the initial and recurrent risk among older individuals is less clear. Objectives: We set out to examine the initial and 1-year recurrent risk of hyperkalemia by level of kidney function (estimated glomerular filtration rate, eGFR) in older adults (≥66 years old). Design: Population-based, retrospective cohort study Settings: Ontario, Canada Participants: 905 167 individuals (≥66 years old) from 2008 to 2015. Measurements: Serum potassium values Methods: Individuals were stratified by eGFR (≥90, 60-89, 30-59, 15-29 mL/min/1.73 m 2 ) and examined for the risk of incident hyperkalemia (K ≥ 5.5 mEq/L) using adjusted Cox proportional hazards models. The 1-year risk of recurrent hyperkalemia was examined using multivariable Andersen-Gill models. Results: Among a population of 905 167 individuals (15% eGFR ≥ 90, 58% eGFR 60-89, 25% eGFR 30-59, 3% eGFR 15-29) with a potassium measurement, there were a total of 18 979 (2.1%) individuals with hyperkalemia identified. The event rate (per 1000 person-years) and adjusted hazard ratio (HR) of hyperkalemia was inversely associated with eGFR (mL/min; eGFR >90 mL/min: 8.8, referent, 60-89 mL/min: 11.8 HR 1.41; eGFR 30-59: 39.8, HR 4.37; eGFR 15-29: 133.6, 13.65) and with an increasing urine albumin-to-creatinine ratio (ACR, mg/mmol; ACR< 3: 14, referent, ACR 3-30: 35.1, HR 1.98; ACR >30: 93.7, 4.71). The 1-year event rate and adjusted risk of recurrent hyperkalemia was similarly inversely associated with eGFR (eGFR ≥ 90: 10.1, referent, eGFR 60-89: 14.4, HR 1.47; eGFR 30-59: 54.8, HR 4.90; eGFR 15-29: 208.0, HR 12.98). Among individuals with a baseline eGFR of 30 to 59 and 15 to 29, 0.9 and 3.8% had greater than 2 hyperkalemia events. The relative risk of initial and recurrent hyperkalemia was marginally higher with RAAS blockade. Roughly 1 in 4 individuals with hyperkalemia required hospitalization the day of or within 30 days after their hyperkalemia event. Limitations: Limited to individuals aged 66 years and above. Conclusions: Patients with low eGFR are at a high risk of initial and recurrent hyperkalemia. Trial registration: N/A – Name: TypeDocument Label: Document Type Group: TypDoc Data: article – Name: Format Label: File Description Group: SrcInfo Data: electronic resource – Name: Language Label: Language Group: Lang Data: English – Name: ISSN Label: ISSN Group: ISSN Data: 2054-3581<br />20543581 – Name: NoteTitleSource Label: Relation Group: SrcInfo Data: https://doaj.org/toc/2054-3581 – Name: DOI Label: DOI Group: ID Data: 10.1177/20543581211017408 – Name: URL Label: Access URL Group: URL Data: <link linkTarget="URL" linkTerm="https://doaj.org/article/1ff8ebf06d0d42fc96afdd96f5e9de62" linkWindow="_blank">https://doaj.org/article/1ff8ebf06d0d42fc96afdd96f5e9de62</link> – Name: AN Label: Accession Number Group: ID Data: edsdoj.1ff8ebf06d0d42fc96afdd96f5e9de62 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1177/20543581211017408 Languages: – Text: English Subjects: – SubjectFull: Diseases of the genitourinary system. Urology Type: general – SubjectFull: RC870-923 Type: general Titles: – TitleFull: Initial and Recurrent Hyperkalemia Events in Patients With CKD in Older Adults: A Population-Based Cohort Study Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Sriram Sriperumbuduri – PersonEntity: Name: NameFull: Eric McArthur – PersonEntity: Name: NameFull: Gregory L. Hundemer – PersonEntity: Name: NameFull: Mark Canney – PersonEntity: Name: NameFull: Navdeep Tangri – PersonEntity: Name: NameFull: Silvia J. Leon – PersonEntity: Name: NameFull: Sara Bota – PersonEntity: Name: NameFull: Ann Bugeja – PersonEntity: Name: NameFull: Ayub Akbari – PersonEntity: Name: NameFull: Greg Knoll – PersonEntity: Name: NameFull: Manish M. Sood IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 05 Type: published Y: 2021 Identifiers: – Type: issn-print Value: 20543581 Numbering: – Type: volume Value: 8 Titles: – TitleFull: Canadian Journal of Kidney Health and Disease Type: main |
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