Abstract 13320: Effect of Cardiovascular Comorbidities on the Mortality Risk Associated with Serum Potassium
Introduction: Both hypokalemia and hyperkalemia are known to be associated with an increased mortality risk. The serum potassium (K+) levels associated with these risks and the relationships to comorbidity, however, are not well defined. We therefore evaluated the odds of death in patients with and without comorbid conditions, stratified by K+ level.
Methods: De-identified medical records (2007-2012) from a large U.S. population of persons ≥ 5 years of age with at least 2 K+ readings were evaluated. Patients 45-64 years of age with comorbidities defined as CKD stages 3-5, heart failure, diabetes, hypertension, and cardiovascular disease (n=231,070) were identified from demographic data, ICD-9 codes and biochemical data, excluding those with acute kidney injury or end stage renal disease, and compared with controls having none of these conditions (n=146,645). A separate analysis of patients ≥ 65 years of age was performed. Index K+ value was defined as the last reported value prior to pre-determined cut-off date. Mortality was evaluated through hospital discharge records and Social Security registry information.
Results: Among patients aged 45-64 with comorbid conditions, index K+ levels below 4.1 mEq/L and above 4.6 mEq/L demonstrate a significant increase in mortality (Figure). This finding was similar in patients ≥ 65 years of age. The general pattern remained after adjustments for demographic characteristics (sex, race) and subgroup analyses controlling for comorbidities associated with the propensity to develop hypo- and hyperkalemia.
Conclusions: These results indicate that the level of potassium and the risk of mortality in patients with hypokalemia or hyperkalemia is highly associated with underlying disease; is significantly greater in patients with comorbid conditions; and is independent of demographic characteristics. The increased mortality in patients with comorbidity occurs even at K+ levels within the usual normal laboratory range.
Author Disclosures: B. Pitt: Honoraria; Significant; Novartis. Ownership Interest; Significant; Relylpsa. Consultant/Advisory Board; Modest; Eli Lilly, Takeda, Sarfez, Stealth Peptides, Johnson and Johnson. Consultant/Advisory Board; Significant; Relypsa, Pfizer, Bayer, scPharmaceuticals, Juventis, DaVinci Therapeutics. A.J. Collins: Employment; Significant; Hennepin Health System. Research Grant; Modest; Amgen, NxStage, Keryx, ZS Pharma. Honoraria; Modest; Amgen, NxStage, Keryx, ZS Pharma. Consultant/Advisory Board; Modest; Amgen, NxStage, Keryx, ZS Pharma, DaVita Clinical Research, IKEA-J, Hospira. Other; Modest; NKF KDIGO, NKF KDPN, WHO, Kidney Health Australia. N. Reaven: Employment; Significant; Strategic Health Resources. Consultant/Advisory Board; Significant; Relypsa, Inc. S. Funk: Employment; Significant; Strategic Health Resources. Consultant/Advisory Board; Significant; Relypsa, Inc. G.L. Bakris: Research Grant; Modest; Takeda (direct funding to Univ. of Chicago). Other Research Support; Modest; Medtronic (direct funding to Univ. of Chicago), Relypsa (direct funding to Univ. of Chicago). Consultant/Advisory Board; Modest; Takeda, AbbVie, CVRx, Janssen, Eli Lilly/Boeringher-Ingelheim, Medtronic, BMS, Novartis, GSK, Bayer. D.A. Bushinsky: Employment; Significant; University of Rochester School of Medicine. Research Grant; Significant; NIH, Renal Research Institute. Honoraria; Modest; OPKO. Honoraria; Significant; Amgen, Relypsa, Sanofi, Tricidia. Ownership Interest; Significant; Amgen, Bristol-Myers Squibb, Relypsa, Tricidia, Merck. Consultant/Advisory Board; Modest; OPKO. Consultant/Advisory Board; Significant; Amgen, Relypsa, Sanofi, Tricidia.
- © 2014 by American Heart Association, Inc.