Hyperkalemia common, linked to poor outcomes in diabetes
medwireNews: A population-based study shows that hyperkalemia is common in people with diabetes, and is associated with hospital admissions and mortality risk.
The researchers found that one in every six people with diabetes had a hyperkalemic event within a few years of starting on glucose-lowering medications. These events were diagnosed from blood tests taken during routine clinical practice.
The mortality rate during the 6 months after an episode was 20%, reports the team in Diabetic Medicine.
“[O]ur data highlight that careful monitoring of potassium and creatinine levels is very important, in accordance with international diabetes guidelines, because hyperkalaemia is associated with several adverse clinical outcomes,” say Reimar Thomsen (Aarhus University Hospital, Denmark) and study co-authors.
Using a registry of all people living in Northern Denmark during 2000−2012, the team identified 68,601 patients, aged a median of 62 years, who were receiving glucose-lowering medications, including insulin. During an average 4.1 years of follow-up, 16% of these individuals had a first hyperkalemic event, which occurred a median of 2 years after their first requirement for glucose-lowering medications.
Forty-four percent of these people developed a second episode, of whom 57% had a third episode, with 65% of these having a fourth, at “successively shorter” time intervals.
Patients who developed hyperkalemia had poorer glucose control than those without, were more likely to be using insulin monotherapy, and had more comorbidities including heart failure and chronic kidney disease. The incidence of hyperkalemia “clearly increased with declining renal function,” the researchers note.
The team found that the incidence of poor outcomes increased during the 6 months after versus before the hyperkalemic event, at 50% versus 31% for acute hospitalizations, 27% versus 16% for receiving a cardiac hospital diagnosis, 14% versus 2% for intensive care unit admissions, and 0.7% versus 0.1% for cardiac arrest.
The risk for these outcomes, and for ventricular arrhythmias specifically, was significantly increased in people with hyperkalemia relative to people without who were matched for factors including age, sex, diabetes duration, Charlson comorbidity index, and glycated hemoglobin level. Mortality risk was elevated a significant 6.47-fold.
The researchers emphasize that their study design cannot prove that hyperkalemia directly causes these adverse outcomes, noting that “[t]he exact order of events in the pathophysiological pathway leading to an acute hospitalization is difficult to disentangle.”
Nevertheless, the authors of an accompanying commentary, Farheen Dojki (University of Illinois at Chicago, USA) and George Bakris (University of Chicago Medicine), say that “[g]iven the cardiovascular risks of hyperkalaemia and its relative lack of symptoms, vigilance to identify and prevent its development is crucial.”
They highlight the existence of medications that can be taken on a long-term basis to reduce hyperkalemia risk, such as the potassium exchange resin patiromer.
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