Patterns and risk factors of hyperkalemia recurrence among heart failure patients

Background Hyperkalemia, a life-threatening electrolyte condition, is linked to arrhythmias and sudden death, but evidence on its recurrence in heart failure (HF) patients is limited. Methods We conducted a cohort study using de-identified EHR data from TriNetX Dataworks USA (study period: January 1, 2019, to June 30, 2023). HF patients who experienced hyperkalemia were included. Study outcomes included the percentage experiencing recurrent hyperkalemia (K+ >5.0 mmol/L), number and timing of recurrences, and K+ at each recurrence. Risk factors for hyperkalemia recurrence were identified using multivariable logistic regression and validated with Monte Carlo simulation. Subgroup analyses were performed for patients without baseline CKD (i.e., eGFR >60 mL/min/1.73 m² and no CKD/ESRD diagnosis). Results The study cohort comprised 15,512 patients (median age 68 years, 42.3% female, 60.5% White, 21.4% Black). Within 12 months, recurrent hyperkalemia was commonly observed in the full cohort (49.5%) and No-CKD subgroup (37.3%). Mean number of recurrences was 2.5 and 2.0, respectively; mean K+ at each recurrence was ∼5.5 mmol/L; and time to recurrence decreased with each successive event. Significant risk factors for recurrence included history of hyperkalemia (OR 2.3, 95% CI: 2.1–2.5), hypertension, advanced CKD, immunosuppressant therapy, and malignancy. Conclusions In this real-world cohort of HF patients, hyperkalemia recurrence was common regardless of renal function status, with increasing frequency and decreasing time intervals between subsequent recurrences. History of hyperkalemia was the strongest risk factor for recurrent hyperkalemia. Further research focused on hyperkalemia management in HF patients is warranted to prevent future recurrences and improve patient outcomes.