Hyperkalaemia in people with diabetes: occurrence, risk factors and outcomes in a Danish population‐based cohort study

• Published in: Diabetic medicine 2018-08, Vol.35 (8), p.1051-1060
• Main Authors: Thomsen, R. W., Nicolaisen, S. K., Adelborg, K., Svensson, E., Hasvold, P., Palaka, E., Pedersen, L., Sørensen, H. T.
• Format: Article
• Language: English
• Subjects: Aged; Angiotensin; Case-Control Studies; Clinical outcomes; Cohort analysis; Cohort Studies; Denmark - epidemiology; Diabetes; Diabetes Complications - diagnosis; Diabetes Complications - epidemiology; Diabetes mellitus; Diabetes Mellitus - diagnosis; Diabetes Mellitus - epidemiology; Female; Heart diseases; Humans; Hyperkalemia; Hyperkalemia - complications; Hyperkalemia - diagnosis; Hyperkalemia - epidemiology; Incidence; Male; Middle Aged; Population studies; Population-based studies; Potassium; Prognosis; Registries; Risk Factors
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13687

Aims To examine the incidence, risk factors and clinical outcomes of hyperkalaemia in people with diabetes in a real‐world setting. Methods Using Danish health registries, we identified a population‐based cohort of people with first‐time drug‐treated diabetes, in the period 2000−2012. First, the cumulative incidence of hyperkalaemia, defined as first blood test with potassium level >5.0 mmol/l after diabetes treatment initiation, was ascertained. Second, in a case–control analysis, risk factors were compared in people with vs without hyperkalaemia. Third, clinical outcomes were assessed among individuals with hyperkalaemia in a before–after analysis, and among people with and without hyperkalaemia in a matched cohort analysis. Results Of 68 601 individuals with diabetes (median age 62 years, 47% women), 16% experienced hyperkalaemia (incidence rate 40 per 1000 person‐years) during a mean follow‐up of 4.1 years. People who developed hyperkalaemia had a higher prevalence of chronic kidney disease [prevalence ratio 1.74 (95% CI 1.68−1.81)], heart failure [prevalence ratio 2.35 (95% CI 2.18−2.54)], use of angiotensin‐converting enzyme inhibitors [prevalence ratio 1.24 (95% CI 1.20−1.28)], use of spironolactone [prevalence ratio 2.68 (95% CI 2.48−2.88)] and potassium supplements [prevalence ratio 1.59 (95% CI 1.52−1.67)]. In people with diabetes who developed hyperkalaemia, 31% were acutely hospitalized within 6 months before hyperkalaemia, increasing to 50% 6 months after hyperkalaemia [before–after risk ratio 1.67 (95% CI 1.61−1.72)]. The 6‐month mortality rate after hyperkalaemia was 20%. Compared with matched individuals without hyperkalaemia, the hazard ratio for death was 6.47 (95% CI 5.81−7.21). Conclusions One in six newly diagnosed people with diabetes experienced a hyperkalaemic event, which was associated with severe clinical outcomes and death. What's new? In this population‐based cohort study we investigated the risk and prognosis of hyperkalaemia (blood potassium level >5.0 mmol/l) in people with diabetes in everyday clinical practice. Among 68 601 individuals with diabetes treated with first glucose‐lowering drug, one in six developed hyperkalaemia over a mean follow‐up of 4.1 years. The risk of developing hyperkalaemia was strongly associated with degree of reduced kidney function and heart failure, and recurrent hyperkalaemia was frequent. Hyperkalaemia was associated with severe clinical outcomes including arrhythmias, intensive care unit admi