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Abstract 234: Prevalence and Prognosis of Hyperkalemia in Dialysis and Non-Dialysis Patients with Acute Myocardial Infarction


 Background:
 Hyperkalemia is a potentially dangerous complication during hospitalization for acute myocardial infarction (AMI), but its prevalence and prognostic importance in contemporary practice have not been described.
 
 
 Methods:
 We studied consecutive patients with AMI from 67 hospitals in the Cerner Health Facts database to assess the association between maximum in-hospital potassium levels (max K) and in-hospital mortality. Patients were stratified by dialysis status, and grouped into categories of max K (<5 mEq/L, 5-<5.5 mEq/L, 5.5-<6.0 mEq/L, 6.0-<6.5 mEq/L, and ≥ 6.5 mEq/L). Multivariable hierarchical logistic regression was used to adjust for multiple patient and site characteristics.
 
 
 Results:
 Of 38,689 patients, 886 (2.3%) were on dialysis. Hyperkalemia (max K ≥ 5.0 mEq/L) occurred in 23.6% of the overall cohort; 22.6% of non-dialysis patients; and 66.8% of dialysis patients. Moderate-severe hyperkalemia (max K ≥ 5.5 mEq/L) occurred in 9.8% of patients. There was an increase in mortality with higher max K levels; this relationship was linear in non-dialysis patients, while a plateau was observed in dialysis patients (Figure). Regardless of dialysis status, in-hospital mortality exceeded 15% once max K ≥5.5 mEq/L. The relationship between max K and mortality persisted after multivariable adjustment (adjusted odds ratios [OR] for max K of 5-<5.5, 5.5-<6.0, 6.0-<6.5, ≥ 6.5 vs. <5 were 2.03 (95% CI 1.79-2.31), 2.79 (2.35-3.31), 4.62 (3.74-5.71), 4.97 (3.96-6.25) respectively for dialysis patients; and 1.62 (1.41-1.87), 2.02 (1.68-2.43), 3.18 (2.51-4.03), 3.37 (2.60-4.36) respectively for non-dialysis patients).
 
 
 Conclusions:
 Hyperkalemia occurs in >20% of non-dialysis and >65% of dialysis patients with AMI. There is a graded mortality increase with higher max K levels, particularly in non-dialysis patients, with marked increases in mortality at even mild levels of hyperkalemia. Additional research into the determinants, pathophysiology, and clinical scenarios in which hyperkalemia contributes to mortality is warranted.
 
 
 
