Hyperkalemia in Real-World Patients Under Continuous Medical Care in Japan
Introduction: An abnormal serum potassium (S-K) level is an important electrolyte disturbance. However, its relation to clinical outcomes in real-world patients, particularly hyperkalemia burden, is not extensively studied. Methods: An observational retrospective cohort study using a Japanese hospit...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-09-01
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| Series: | Kidney International Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S246802491930213X |
| _version_ | 1818147276420284416 |
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| author | Naoki Kashihara Shun Kohsaka Eiichiro Kanda Suguru Okami Toshitaka Yajima |
| author_facet | Naoki Kashihara Shun Kohsaka Eiichiro Kanda Suguru Okami Toshitaka Yajima |
| author_sort | Naoki Kashihara |
| collection | DOAJ |
| description | Introduction: An abnormal serum potassium (S-K) level is an important electrolyte disturbance. However, its relation to clinical outcomes in real-world patients, particularly hyperkalemia burden, is not extensively studied. Methods: An observational retrospective cohort study using a Japanese hospital claims database was done (April 2008–September 2017; N = 1,022,087). Associations between index S-K level and 3-year survival were modeled using cubic spline regression. Cox regression model was applied to estimate the time to death according to different S-K levels. Prevalence, patient characteristics, treatment patterns, and management of patients with hyperkalemia from first episode were assessed. Results: Hyperkalemia prevalence was 67.9 (95% confidence interval [CI]: 67.1–68.8) per 1000 and increased in patients with chronic kidney disease (CKD) (227.9; 95% CI: 224.3–231.5), heart failure (134.0; 95% CI: 131.2–136.8), and renin-angiotensin-aldosterone system inhibitor (RAASi) use (142.2; 95% CI: 139.6–144.7). U-shaped associations between S-K level and 3-year survival were observed with nadir 4.0 mEq/l. The risk of death was increased at S-K 5.1–5.4 mEq with hazard ratio of 7.6 (95% CI: 7.2–8.0). The 3-year mortality rate in patients with CKD stages 3a, 3b, 4, and 5 with normokalemia were 1.51%, 3.93%, 10.86%, and 12.09%, whereas that in patients with CKD stage 3a at S-K 5.1–5.4, 5.5–5.9, and ≥6.0 mEq/l increased to 10.31%, 11.43%, and 22.64%, respectively. Despite treatment with loop diuretics (18.5%) and potassium binders (5.8%), >30% of patients had persistently high S-K (≥5.1 mEq/l). Conclusion: This study provides real-world insight on hyperkalemia based on a large number of patients with various medical backgrounds. Keywords: chronic kidney disease, congestive heart failure, hyperkalemia, renin-angiotensin-aldosterone inhibitor, renin angiotensin system |
| first_indexed | 2024-12-11T12:32:40Z |
| format | Article |
| id | doaj.art-82d259bad3b2404eab1260c5b785d840 |
| institution | Directory Open Access Journal |
| issn | 2468-0249 |
| language | English |
| last_indexed | 2024-12-11T12:32:40Z |
| publishDate | 2019-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj.art-82d259bad3b2404eab1260c5b785d8402022-12-22T01:07:12ZengElsevierKidney International Reports2468-02492019-09-014912481260Hyperkalemia in Real-World Patients Under Continuous Medical Care in JapanNaoki Kashihara0Shun Kohsaka1Eiichiro Kanda2Suguru Okami3Toshitaka Yajima4Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, JapanDepartment of Cardiology, Keio University School of Medicine, Tokyo, JapanMedical Science, Kawasaki Medical School, Okayama, JapanCardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Osaka, JapanCardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Osaka, Japan; Correspondence: Toshitaka Yajima, AstraZeneca K.K., Tower B Gran Front Osaka, 3–1 Ofukacho, Kita-ku, Osaka-shi, Osaka 530–0011, Japan.Introduction: An abnormal serum potassium (S-K) level is an important electrolyte disturbance. However, its relation to clinical outcomes in real-world patients, particularly hyperkalemia burden, is not extensively studied. Methods: An observational retrospective cohort study using a Japanese hospital claims database was done (April 2008–September 2017; N = 1,022,087). Associations between index S-K level and 3-year survival were modeled using cubic spline regression. Cox regression model was applied to estimate the time to death according to different S-K levels. Prevalence, patient characteristics, treatment patterns, and management of patients with hyperkalemia from first episode were assessed. Results: Hyperkalemia prevalence was 67.9 (95% confidence interval [CI]: 67.1–68.8) per 1000 and increased in patients with chronic kidney disease (CKD) (227.9; 95% CI: 224.3–231.5), heart failure (134.0; 95% CI: 131.2–136.8), and renin-angiotensin-aldosterone system inhibitor (RAASi) use (142.2; 95% CI: 139.6–144.7). U-shaped associations between S-K level and 3-year survival were observed with nadir 4.0 mEq/l. The risk of death was increased at S-K 5.1–5.4 mEq with hazard ratio of 7.6 (95% CI: 7.2–8.0). The 3-year mortality rate in patients with CKD stages 3a, 3b, 4, and 5 with normokalemia were 1.51%, 3.93%, 10.86%, and 12.09%, whereas that in patients with CKD stage 3a at S-K 5.1–5.4, 5.5–5.9, and ≥6.0 mEq/l increased to 10.31%, 11.43%, and 22.64%, respectively. Despite treatment with loop diuretics (18.5%) and potassium binders (5.8%), >30% of patients had persistently high S-K (≥5.1 mEq/l). Conclusion: This study provides real-world insight on hyperkalemia based on a large number of patients with various medical backgrounds. Keywords: chronic kidney disease, congestive heart failure, hyperkalemia, renin-angiotensin-aldosterone inhibitor, renin angiotensin systemhttp://www.sciencedirect.com/science/article/pii/S246802491930213X |
| spellingShingle | Naoki Kashihara Shun Kohsaka Eiichiro Kanda Suguru Okami Toshitaka Yajima Hyperkalemia in Real-World Patients Under Continuous Medical Care in Japan Kidney International Reports |
| title | Hyperkalemia in Real-World Patients Under Continuous Medical Care in Japan |
| title_full | Hyperkalemia in Real-World Patients Under Continuous Medical Care in Japan |
| title_fullStr | Hyperkalemia in Real-World Patients Under Continuous Medical Care in Japan |
| title_full_unstemmed | Hyperkalemia in Real-World Patients Under Continuous Medical Care in Japan |
| title_short | Hyperkalemia in Real-World Patients Under Continuous Medical Care in Japan |
| title_sort | hyperkalemia in real world patients under continuous medical care in japan |
| url | http://www.sciencedirect.com/science/article/pii/S246802491930213X |
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