1
|
Ahdoot RS, Hsiung JT, Agiro A, Brahmbhatt YG, Cooper K, Fawaz S, Westfall L, Kalantar-Zadeh K, Streja E. Liver Disease Is a Risk Factor for Recurrent Hyperkalemia: A Retrospective Cohort Study. J Clin Med 2023; 12:4562. [PMID: 37510679 PMCID: PMC10380673 DOI: 10.3390/jcm12144562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Liver disease is often associated with dysfunctional potassium homeostasis but is not a well-established risk factor for hyperkalemia. This retrospective cohort study examined the potential relationship between liver disease and recurrent hyperkalemia. Patients with ≥1 serum potassium measurement between January 2004 and December 2018 who experienced hyperkalemia (serum potassium >5.0 mmol/L) were identified from the United States Veterans Affairs database. A competing risk regression model was used to analyze the relationship between patient characteristics and recurrent hyperkalemia. Of 1,493,539 patients with incident hyperkalemia, 71,790 (4.8%) had liver disease (one inpatient or two outpatient records) within 1 year before the index hyperkalemia event. Recurrent hyperkalemia within 1 year after the index event occurred in 234,807 patients (15.7%) overall, 19,518 (27.2%) with liver disease, and 215,289 (15.1%) without liver disease. The risk of recurrent hyperkalemia was significantly increased in patients with liver disease versus those without (subhazard ratio, 1.34; 95% confidence interval, 1.32-1.37; p < 0.0001). Aside from vasodilator therapy, the risk of recurrent hyperkalemia was not increased with concomitant medication. In this cohort study, liver disease was an independent risk factor strongly associated with recurrent hyperkalemia within 1 year, independent of concomitant renin-angiotensin-aldosterone system inhibitor or potassium-sparing diuretic use.
Collapse
Affiliation(s)
- Rebecca S Ahdoot
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine, Irvine, CA 92868, USA
| | - Jui-Ting Hsiung
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine, Irvine, CA 92868, USA
- Veterans Affairs Long Beach Healthcare System, 5901 East 7th Street, Long Beach, CA 90822, USA
| | - Abiy Agiro
- AstraZeneca, US Evidence, US Medical Affairs, Wilmington, DE 19803, USA
| | | | - Kerry Cooper
- AstraZeneca, US Renal, US Medical Affairs, Wilmington, DE 19803, USA
| | - Souhiela Fawaz
- AstraZeneca, US Renal, US Medical Affairs, Wilmington, DE 19803, USA
| | - Laura Westfall
- AstraZeneca, US Renal, US Medical Affairs, Wilmington, DE 19803, USA
| | - Kamyar Kalantar-Zadeh
- Veterans Affairs Long Beach Healthcare System, 5901 East 7th Street, Long Beach, CA 90822, USA
- Harbor UCLA Medical Center, Nephrology, University of California Los Angeles, Los Angeles, CA 90502, USA
| | - Elani Streja
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine, Irvine, CA 92868, USA
- Veterans Affairs Long Beach Healthcare System, 5901 East 7th Street, Long Beach, CA 90822, USA
| |
Collapse
|
2
|
Characteristics, Risk Factors, and Adverse Outcomes of Hyperkalemia in Acute-on-Chronic Liver Failure Patients. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6025726. [PMID: 30937312 PMCID: PMC6415283 DOI: 10.1155/2019/6025726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/24/2018] [Indexed: 12/23/2022]
Abstract
Background Hyperkalemia is a serious complication in cirrhotic patients. However, the clinical characteristics, risk factors, and its impact on the outcomes in acute-on-chronic liver failure (ACLF) patients remain unclear. Methods We retrospectively recruited 650 ACLF patients in this study. The risk factors associated with hyperkalemia and its relationship with 90-day mortality were analyzed using multivariable regression models. Results Among 650 patients with ACLF, 12.2% (79/650) had hyperkalemia during hospitalization. Higher admission serum potassium levels and the presence of acute kidney injury (AKI) were independent risk factors for hyperkalemia. The prevalence rates of hyperkalemia in patients with and without AKI were 23.6% and 4.6%, respectively (P<0.001). Hyperkalemia was a predictor of mortality in AKI and non-AKI patients. The 90-day mortality rates in non-AKI patients with and without hyperkalemia were 44.4% and 24.7%, respectively (P<0.001), and in AKI patients with and without hyperkalemia were 80.3% and 56.6%, respectively (P<0.001). Hepatic encephalopathy (HE), gastrointestinal bleeding, AKI, hyperkalemia, elevated total bilirubin (TBIL) and international normalized ratio (INR) values, and higher Model for End-Stage Liver Disease (MELD) and chronic liver failure-sequential organ failure assessment (CLIF-SOFA) scores were independent risk factors for predicting the 90-day mortality in ACLF patients. Conclusions Hyperkalemia increases the 90-day mortality in ACLF patients; hyperkalemia is associated with AKI. Patients with both AKI and hyperkalemia had the worst outcome.
Collapse
|
3
|
Musso CG, Juarez R, Glassock RJ. Water, electrolyte, acid–base, and trace elements alterations in cirrhotic patients. Int Urol Nephrol 2017; 50:81-89. [DOI: 10.1007/s11255-017-1614-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/02/2017] [Indexed: 12/20/2022]
|
4
|
Yamazaki Y, Sato K, Kakizaki S, Nagashima T, Tojima H, Hashizume H, Ohyama T, Horiguchi N, Kusano M, Yamada M. The relationship between renin angiotensin system inhibitor and serum potassium increase during combination therapy with Daclatasvir and Asnaplevir for chronic hepatitis C. KANZO 2015; 56:324-331. [DOI: 10.2957/kanzo.56.324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
- Yuichi Yamazaki
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine
| | - Ken Sato
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine
| | - Satoru Kakizaki
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine
| | - Tamon Nagashima
- Department of Digestive Organ Internal Medicine, National Hospital Organization Nishigunma National Hospital
| | - Hiroki Tojima
- Department of Digestive Organ Internal Medicine, National Hospital Organization Nishigunma National Hospital
| | - Hiroaki Hashizume
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine
| | - Tatsuya Ohyama
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine
| | - Norio Horiguchi
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine
| | - Motoyasu Kusano
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine
| | - Masanobu Yamada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine
| |
Collapse
|