Hypokalemia and Outcomes in Patients With Chronic Heart Failure and Chronic Kidney Disease
Why the study?
Does hypokalemia increase mortality and hospitalization in patients with chronic heart failure and chronic kidney disease?
Population
2,793 patients with chronic heart failure and chronic kidney disease from the Digitalis Investigation Group…
Comparison
Hypokalemia (serum potassium <4 mEq/L) vs Normokalemia (serum potassium 4 to 4.9 mEq/L)
Design
Cohort
Follow-up
57 months
Authors
Discussion
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Member takes
Implication
Hypokalemia was associated with higher mortality in HF with CKD; leaves open whether correction improves outcomes.
Key Points
- To evaluate the association between hypokalemia (serum potassium <4 mEq/L) and clinical outcomes, including mortality and hospitalizations, in patients with chronic heart failure and chronic kidney disease.
- Analyzed 2,793 patients with chronic heart failure and chronic kidney disease (eGFR <60 mL/min per 1.73 m²) from the Digitalis Investigation Group trial over a median follow-up of 57 months.
- Used propensity score matching to construct a balanced cohort of 522 pairs of patients with hypokalemia (<4 mEq/L) and normokalemia (4.0 to 4.9 mEq/L).
- All-cause mortality occurred in 48% of patients with hypokalemia compared to 36% with normokalemia (matched HR 1.56; 95% CI, 1.25 to 1.95; P<0.0001).
- Hypokalemia significantly increased cardiovascular mortality (matched HR 1.65; 95% CI, 1.29 to 2.11; P<0.0001), heart failure mortality (matched HR 1.82; 95% CI, 1.28 to 2.57; P<0.0001), and all-cause hospitalization (matched HR 1.16; 95% CI, 1.00 to 1.35; P=0.036).
- Mild hypokalemia (3.5 to 3.9 mEq/L) independently increased all-cause mortality (47% vs. 38%; matched HR 1.31; 95% CI, 1.03 to 1.66; P=0.027), as did hypokalemia in patients with eGFR <45 mL/min per 1.73 m² (57% vs. 47%; matched HR 1.53; 95% CI, 1.07 to 2.19; P=0.020).
Structured PICO
Does hypokalemia increase mortality and hospitalization in patients with chronic heart failure and chronic kidney disease?
P
Population
2,793 patients with chronic heart failure and chronic kidney disease (estimated glomerular filtration rate <60 mL/min per 1.73 m2) from the Digitalis Investigation Group trial.
I
Intervention
Hypokalemia (serum potassium <4 mEq/L)
C
Comparator
Normokalemia (serum potassium 4 to 4.9 mEq/L)
O
Outcome
All-cause mortality during 57 months of follow-uphard clinical
In patients with chronic heart failure and chronic kidney disease, hypokalemia (<4 mEq/L) is associated with significantly increased risks of mortality and hospitalization.
Cite This Study
Bowling et al. (2010) studied this question.