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Abstract: FR-PO544

Impact of Hyperkalemia on Mortality in Patients With Advanced Kidney Disease With and Without Hemodialysis: Implications for Deferring Hemodialysis Initiation Under Value-Based Models

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Authors

  • Streja, Elani, University of California Irvine, Irvine, California, United States
  • Hsiung, Jui-Ting, University of California Irvine, Irvine, California, United States
  • Agiro, Abiy, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Fawaz, Souhiela, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Westfall, Laura, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Oluwatosin, Yemisi, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
Background

The relationship between hyperkalemia (HK) and mortality in patients with stage 5 chronic kidney disease (CKD) or end-stage kidney disease (ESKD) with or without hemodialysis (HD) is not well established. This study examines the relationship between HK and all-cause mortality and whether it is dependent on HD initiation.

Methods

This retrospective cohort study of the United States (US) Veterans Affairs database identified 14,681 individuals initiating HD (HD cohort, N=5063) or with estimated glomerular filtration rate (eGFR) <10 mL/min/1.73m2 but not on HD (non-HD cohort, N=9618) who had at least one potassium (K+) measurement within 30 days of HD or eGFR index date and complete data for covariates. The association between HK (K+ >5.0 mEq/L) and all-cause mortality was analyzed by Cox regression analysis.

Results

In the total cohort, 8548 (58.2%) individuals had HK within 1 year prior to index (baseline HK). A greater proportion of the HD cohort than the non-HD cohort had baseline HK (69.6% and 52.3%, respectively). All-cause mortality rates within 1 year post-index in the HD and non-HD cohorts were 11.3% and 20.5%, respectively. After adjustment for baseline HK, demographic characteristics, comorbidities, medication use, and baseline eGFR, HD was associated with a 60% decrease in 1-year all-cause mortality compared with no HD (adjusted hazard ratio [aHR] 0.40; 95% CI 0.37–0.44; P<0.0001. In the total cohort, 1-year all-cause mortality rates for those with and without baseline HK were 21.9% and 11.0%, respectively. Baseline HK was associated with a 50% increase in 1-year all-cause mortality compared with no baseline HK (aHR 1.50; 95% CI 1.37–1.64; P<0.0001).

Conclusion

HK was a strong independent risk factor for all-cause mortality among patients with stage 5 CKD/ESKD with and without HD. Patients with stage 5 CKD/ESKD managed conservatively without HD likely have less control of HK than those receiving HD. These data may have important implications for the goal of deferring HD initiation under value-based models.

Funding

  • Veterans Affairs Support – AstraZeneca