PUK4 WHERE IS HYPERKALEMIA DIAGNOSED AND DOES IT MATTER? RESULTS FROM A LARGE EMR NETWORK IN THE US

Abstract

The aims of this analysis were to examine health outcomes and treatment-related differences among incident hyperkalemia patients diagnosed in ambulatory, inpatient, and emergency room (ER) settings. Patients with an incident hyperkalemia diagnosis, confirmed by serum potassium (K) ≥5.0 mmol/L, following a kidney disease diagnosis between 2010-2018 were identified using a US-based electronic medical record network. Treatment administered on the same day, health outcomes within 30-days, and retesting of K within 30-days and 1-year following a first diagnosis were compared across ambulatory, inpatient and ER settings using chi-square tests and Kaplan-Meier curves. All criteria were defined by ICD-9/10, LOINC, CPT, and RxNorm codes. The mean age was 68 in inpatient (N= 8,875), 66 in ambulatory (N=3,471), and 67 in ER (N=1,906) settings. All treatments for hyperkalemia were used with greater frequency in inpatient settings. Insulin was the most common treatment in each setting (38.2%, 25.6%, 25.7% in inpatient, ambulatory, and ER, respectively). Hemodialysis was 3-times as likely to occur in an inpatient setting than an ER (6.1% vs. 2.0%). No difference was observed in patiromer or sodium polystyrene sulfonate. Acute kidney failure, heart failure, cardiac arrest and cardiac arrhythmia were most likely to occur in an ER and least likely to occur within an inpatient setting. In the 30-days following diagnosis, inpatients were most likely to have their K retested. After a year, most patients were retested (>95%), regardless of setting. All differences p<0.05. Novel treatments require a diagnosis of chronic hyperkalemia. Although previous studies show retesting is uncommon, especially in primary care settings, most patients in our study receive a second K test within a year of the incident event, regardless of setting. Treatment and health outcomes differ by setting, indicating a need to address under-served segments of the hyperkalemia patient population.