Abstract 234: Prevalence and Prognosis of Hyperkalemia in Dialysis and Non-Dialysis Patients with Acute Myocardial Infarction
Background: Hyperkalemia is a potentially dangerous complication during hospitalization for acute myocardial infarction (AMI), but its prevalence and prognostic importance in contemporary practice have not been described.
Methods: We studied consecutive patients with AMI from 67 hospitals in the Cerner Health Facts database to assess the association between maximum in-hospital potassium levels (max K) and in-hospital mortality. Patients were stratified by dialysis status, and grouped into categories of max K (<5 mEq/L, 5-<5.5 mEq/L, 5.5-<6.0 mEq/L, 6.0-<6.5 mEq/L, and ≥ 6.5 mEq/L). Multivariable hierarchical logistic regression was used to adjust for multiple patient and site characteristics.
Results: Of 38,689 patients, 886 (2.3%) were on dialysis. Hyperkalemia (max K ≥ 5.0 mEq/L) occurred in 23.6% of the overall cohort; 22.6% of non-dialysis patients; and 66.8% of dialysis patients. Moderate-severe hyperkalemia (max K ≥ 5.5 mEq/L) occurred in 9.8% of patients. There was an increase in mortality with higher max K levels; this relationship was linear in non-dialysis patients, while a plateau was observed in dialysis patients (Figure). Regardless of dialysis status, in-hospital mortality exceeded 15% once max K ≥5.5 mEq/L. The relationship between max K and mortality persisted after multivariable adjustment (adjusted odds ratios [OR] for max K of 5-<5.5, 5.5-<6.0, 6.0-<6.5, ≥ 6.5 vs. <5 were 2.03 (95% CI 1.79-2.31), 2.79 (2.35-3.31), 4.62 (3.74-5.71), 4.97 (3.96-6.25) respectively for dialysis patients; and 1.62 (1.41-1.87), 2.02 (1.68-2.43), 3.18 (2.51-4.03), 3.37 (2.60-4.36) respectively for non-dialysis patients).
Conclusions: Hyperkalemia occurs in >20% of non-dialysis and >65% of dialysis patients with AMI. There is a graded mortality increase with higher max K levels, particularly in non-dialysis patients, with marked increases in mortality at even mild levels of hyperkalemia. Additional research into the determinants, pathophysiology, and clinical scenarios in which hyperkalemia contributes to mortality is warranted.
Author Disclosures: A. Grodzinsky: None. A. Goyal: None. K. Gosch: None. P.A. McCullough: None. G. Fonarow: G. Consultant/Advisory Board; Modest; ZS Pharma. G. Consultant/Advisory Board; Significant; Novartis. B. Palmer: None. F.A. Masoudi: None. J.A. Spertus: None. M. Kosiborod: G. Consultant/Advisory Board; Modest; ZS Pharma.
- © 2014 by American Heart Association, Inc.