P0837hyperkalemia in Renal Patients, the Great Forgot?

Abstract

Background and Aims Hyperkalemia constitutes an electrolyte imbalance that frequently appears in patients with Chronic Renal Disease (CKD) and is related to an increase in morbidity and mortality. Today, computerization of laboratory systems allows us to have access to these data to analyze the real prevalence of hyperkalemia in these patients, which we currently do not know. Our purpose is to analyze the frequency and characteristics of nephrologic patients with hyperkalemia and identify the most prevalent areas. Method Using a coding established by the laboratory, we have selected all patients with potassium greater than 5.5 mEq / l in analytics requested by any nephrologist of our hospital during the months of January to March 2019. It was established as mild hyperkalemia values up to 5.5mEq / l, and up to 6.5 mEq / l, severe hyperkalemia. We retrospectively analyzed the characteristics of these patients and the prevalence according to etiology and units within our service, relating potassium levels to the prescription of hyperkalemiant or related drugs. Results After analyzing the data, using as a reference the total number of patients seen in each area, we obtain an estimated total prevalence of 3.5% (86/2480). We found a distribution by sex with a predominance of men (56%), with a mean age of 62 years. The highest prevalence is obtained in the Hemodialysis unit (39.8%), followed by Peritoneal Dialysis (11%), Transplantation (5%), Hospitalization (4.3%), Interconsultations (3.8%), ERCA (2.7%) and External Consultations (0.6%). 65% had moderate hyperkalemia (defined as potassium levels of 5.5-6.5 mEq / l). Regarding the etiology of CKD, the most prevalent were: Vascular (29.2%), Diabetic (20.7%), Glomerular (19.5%) and Interstitial (14.6%). These etiologies also coincide with higher mean potassium levels, although without significant differences. There is also an increase in potassium levels the lower the glomerular filtration rate. However, when performing linear regression analysis we found no significant differences. Analyzing the drugs, it should be noted that the patients with the highest potassium levels were those taking anticoagulants, anticalcineurinics or resins (mean 6.17 mEq / l), finding significant differences only with the resins. In addition, most did not take ACE inhibitors, ARA-II or Beta blockers. Conclusion The prevalence of hyperkalemia in our population represents 3.5%. Being in most cases mild-moderate. The prevalence of hyperkalemia is higher in protein and kidney nephropathies and vascular nephropathies, probably associated with increased use of antiproteinuric drugs with hyperkalemic effect. Hyperkalemia is more prevalent in patients in patients undergoing renal replacement therapy reaching 40% in hemodialysis. The prevalence in CKD has been lower than expected, possibly in relation to greater patient awareness and adherence to the indications. Despite not finding a significant relationship, (due to the size of the sample) there is a relationship with the prescription of hyperkalemiant drugs. Resin prescription does not correct hyperkalemia