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Background : Hyperkalemia is a potential threat to patient
safety in chronic kidney disease (CKD). This study
determined the incidence of hyperkalemia in CKD and
whether it is associated with excess mortality.
Methods : This retrospective analysis of a national cohort
comprised 2 103 422 records from 245 808 veterans
with at least 1 hospitalization and at least 1 inpatient
or outpatient serum potassium record during the
fiscal year 2005. Chronic kidney disease and treatment
with angiotensin-converting enzyme inhibitors and/or angiotensin
II receptor blockers (blockers of the reninangiotensin-
aldosterone system [RAAS]) were the key predictors
of hyperkalemia. Death within 1 day of a
hyperkalemic event was the principal outcome.
Results : Of the 66 259 hyperkalemic events (3.2% of records),
more occurred as inpatient events (n=34 937
[52.7%]) than as outpatient events (n=31 322 [47.3%]).
The adjusted rate of hyperkalemia was higher in patients
with CKD than in those without CKD among individuals
treated with RAAS blockers (7.67 vs 2.30 per
100 patient-months; P.001) and those without RAAS
blocker treatment (8.22 vs 1.77 per 100 patientmonths;
P .001). The adjusted odds ratio (OR) of death
with a moderate (potassium, 5.5 and 6.0 mEq/L [to
convert to mmol/L, multiply by 1.0]) and severe (potassium,
6.0 mEq/L) hyperkalemic event was highest with
no CKD (OR, 10.32 and 31.64, respectively) vs stage 3
(OR, 5.35 and 19.52, respectively), stage 4 (OR, 5.73 and
11.56, respectively), or stage 5 (OR, 2.31 and 8.02, respectively)
CKD, with all P.001 vs normokalemia and
no CKD.
Conclusions : The risk of hyperkalemia is increased with
CKD, and its occurrence increases the odds of mortality
within 1 day of the event. These findings underscore the
importance of this metabolic disturbance as a threat to
patient safety in CKD.
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