Santiago Jiménez-Marrero1, Miguel Cainzos-Achirica2, David Monterde3, Emili Vela3, Montse Cleries3, Luis García-Eroles3, Cristina Enjuanes1, Sergi Yun4, Alberto Garay1, Pedro Moliner1, Lidia Alcoberro1, Xavier Corbella5, Josep Comín-Colet6. 1. Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. 2. Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore (MD), United States; Facultad de Medicina y Ciencias de la Salud, Universidad Internacional de Cataluña, Barcelona, Spain. 3. Unitat d'Informació i Coneixement, Servei Català de la Salut (CatSalut), Barcelona, Spain. 4. Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 5. Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Grupo de Evaluación de Determinantes de Salud y Políticas Sanitarias, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Barcelona, Spain. 6. Unidad Multidisciplinar de Insuficiencia Cardiaca Comunitaria (UMICO), Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Ciencias Clínicas, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain. Electronic address: jcomin@bellvitgehospital.cat.
Abstract
INTRODUCTION AND OBJECTIVES: Potassium derangements are frequent among patients with chronic cardiovascular conditions. Studies on the associations between potassium derangements and clinical outcomes have yielded mixed findings, and the implications for health care expenditure are unknown. We assessed the population-based associations between hyperkalemia, hypokalemia and clinical outcomes and health care costs, in patients with chronic heart failure, chronic kidney disease, diabetes mellitus, hypertension, and ischemic heart disease. METHODS: Population-based, longitudinal study including up to 36 269 patients from a health care area with at least one of the above-mentioned conditions. We used administrative, hospital and primary care databases. Participants were followed up between 2015 and 2017, were aged ≥ 55 years and had at least 1 potassium measurement. Four analytic designs were used to evaluate prevalent and incident cases and the use of renin-angiotensin-aldosterone system inhibitors. RESULTS: Hyperkalemia was twice as frequent as hypokalemia. On multivariable-adjusted analyses, hyperkalemia was robustly and significantly associated with an increased risk of all-cause death (HR from Cox regression models ranging from 1.31-1.68) and with an increased odds of a yearly health care expenditure >85th percentile (OR, 1.21-1.29). Associations were even stronger in hypokalemic patients (HR for all-cause death, 1.92-2.60; OR for health care expenditure> percentile 85th, 1.81-1.85). CONCLUSIONS: Experimental studies are needed to confirm whether the prevention of potassium derangements reduces mortality and health care expenditure in these chronic conditions. Until then, our findings provide observational evidence on the potential importance of maintaining normal potassium levels.
INTRODUCTION AND OBJECTIVES:Potassium derangements are frequent among patients with chronic cardiovascular conditions. Studies on the associations between potassium derangements and clinical outcomes have yielded mixed findings, and the implications for health care expenditure are unknown. We assessed the population-based associations between hyperkalemia, hypokalemia and clinical outcomes and health care costs, in patients with chronic heart failure, chronic kidney disease, diabetes mellitus, hypertension, and ischemic heart disease. METHODS: Population-based, longitudinal study including up to 36 269 patients from a health care area with at least one of the above-mentioned conditions. We used administrative, hospital and primary care databases. Participants were followed up between 2015 and 2017, were aged ≥ 55 years and had at least 1 potassium measurement. Four analytic designs were used to evaluate prevalent and incident cases and the use of renin-angiotensin-aldosterone system inhibitors. RESULTS:Hyperkalemia was twice as frequent as hypokalemia. On multivariable-adjusted analyses, hyperkalemia was robustly and significantly associated with an increased risk of all-cause death (HR from Cox regression models ranging from 1.31-1.68) and with an increased odds of a yearly health care expenditure >85th percentile (OR, 1.21-1.29). Associations were even stronger in hypokalemicpatients (HR for all-cause death, 1.92-2.60; OR for health care expenditure> percentile 85th, 1.81-1.85). CONCLUSIONS: Experimental studies are needed to confirm whether the prevention of potassium derangements reduces mortality and health care expenditure in these chronic conditions. Until then, our findings provide observational evidence on the potential importance of maintaining normal potassium levels.
Authors: Antonio Olry de Labry Lima; Óscar Díaz Castro; Jorge M Romero-Requena; M de Los Reyes García Díaz-Guerra; Virginia Arroyo Pineda; M Belén de la Hija Díaz; Meritxell Ascanio; Josep Darbà; Josep M Cruzado Journal: Clin Kidney J Date: 2021-04-07
Authors: Juan F Delgado-Jiménez; Javier Segovia-Cubero; Luis Almenar-Bonet; Javier de Juan-Bagudá; Antonio Lara-Padrón; José Manuel García-Pinilla; Juan Luis Bonilla-Palomas; Silvia López-Fernández; Sonia Mirabet-Pérez; Inés Gómez-Otero; Antonio Castro-Fernández; Beatriz Díaz-Molina; Josebe Goirigolzarri-Artaza; Luis Miguel Rincón-Díaz; Domingo Andrés Pascual-Figal; Manuel Anguita-Sánchez; Javier Muñiz; María G Crespo-Leiro Journal: J Clin Med Date: 2022-02-22 Impact factor: 4.241