Consequences of Recurrent Hyperkalemia on Cardiovascular Outcomes and Mortality

Figures

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  Figure 1. Sample Selection for Recurrent HK and Normokalemia Cohorts Before matching, there were 11,499 patients with recurrent hyperkalemia and 52,725 with normokalemia; 6,337 matched pairs were included in the analysis. CKD = chronic kidney disease; eGFR = estimated glomerular filtration rate; ESKD = end-stage kidney disease; HK = hyperkalemia; K+ = potassium.

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  Figure 2. HRs for All-Cause Mortality HRs and 95% CIs comparing recurrent hyperkalemia and normokalemia cohorts are presented for all-cause mortality in the overall population and heart failure, hypertension, renin-angiotensin-aldosterone system inhibitor, and proteinuria substudies. HK = hyperkalemia.

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  Figure 3. Kaplan-Meier Curves for Cardiovascular Outcomes in the Heart Failure Substudy Median time to death, major adverse cardiovascular event or hospitalization with heart failure, and hospitalized arrhythmia in the heart failure substudy were compared Between patients with recurrent hyperkalemia and those with normokalemia. (A) Time to death in heart failure substudy. (B) Time to MACE+ in heart failure substudy. (C) Time to hospitalized arrhythmia in heart failure substudy. HK = hyperkalemia; IP = inpatient; MACE+ = major adverse cardiovascular events plus.

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  Central Illustration. Consequences of Recurrent Hyperkalemia on Cardiovascular Outcomes and Mortality In a matched cohort study, patients with chronic kidney disease and recurrent hyperkalemia experienced significantly higher risks of mortality, major adverse cardiovascular event or hospitalization with heart failure, and inpatient cardiac arrhythmia compared to patients with chronic kidney disease and no-hyperkalemia. CV outcomes included MACE+ and IP cardiac arrhythmia. Proportions in the figures are the proportion of patients with the events at year 5 based on Kaplan-Meier analyses. Funding or this research was provided by AstraZeneca. CKD = chronic kidney disease; CV = cardiovascular; HK = hyperkalemia; IP = inpatient; MACE+ = major adverse cardiovascular events plus (stroke, myocardial infarction or heart failure occurring in the inpatient setting or all-cause mortality); No-HK = normokalemia; rHK = recurrent hyperkalemia.

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  Figure 4. HRs and Event Breakdown for MACE and MACE+ HRs and 95% CIs comparing recurrent hyperkalemia and normokalemia cohorts are presented for major adverse cardiovascular events and major adverse cardiovascular event or hospitalization with heart failure in the overall population and heart failure, hypertension, renin-angiotensin-aldosterone system inhibitor, and proteinuria substudies. The distribution of major adverse cardiovascular events and major adverse cardiovascular event or hospitalization with heart failure events are reported by cohort. HK = hyperkalemia; MACE = major adverse cardiovascular event; MACE+ = major adverse cardiovascular events plus hospitalization for heart failure; RAASi = renin-angiotensin-aldosterone system inhibitor.

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  Figure 5. HRs and Event Breakdown for Hospitalized Arrhythmia HRs and 95% CIs comparing recurrent hyperkalemia and normokalemia cohorts are presented for arrhythmia in the overall population and heart failure, hypertension, renin-angiotensin-aldosterone system inhibitor, and proteinuria substudies. The distribution of arrhythmia events are reported by cohort. HK = hyperkalemia; RAASi = renin-angiotensin-aldosterone system inhibitor.

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  Figure 6. Median Time to RAASi Discontinuation in the RAASi Substudy Median time to renin-angiotensin-aldosterone system inhibitor discontinuation in patients with renin-angiotensin-aldosterone system inhibitor use was compared between patients with recurrent hyperkalemia and those with normokalemia. HK = hyperkalemia; RAASi = renin-angiotensin-aldosterone system inhibitor.