Emergency department referral and short-term death after outpatient hyperkalemia: a population-based study

BACKGROUND: Hyperkalemia can be deadly, yet clinical decision-making for outpatient management is unclear. We sought to determine whether an emergency department encounter within 24 hours of a severe outpatient hyperkalemia result was associated with lower rates of immediate and short-term all-cause death. METHODS: We conducted a retrospective population-based cohort study in Ontario, Canada, involving adults (age ≥18 yr) with an outpatient potassium result greater than 6.2 mmol/L from Jan. 1, 2007, to Dec. 24, 2021. Patients who presented to the emergency department were propensity matched (1:1) to patients who did not. We estimated risk ratios and risk differences for all-cause death within 1, 3, and 7 days after the encounter. We performed subgroup analyses based on kidney function, sex, diabetes, renin-angiotensin-aldosterone inhibitor use, potassium level, and ordering physician specialty. RESULTS: ). INTERPRETATION: Presentation to the emergency department within 24 hours of a severe outpatient hyperkalemia result is associated with lower rates of immediate and short-term death. These findings support urgent emergency department referrals and underscore the need for standardized reporting and management guidelines.