FACTORS AFFECTING HOSPITAL MORTALITY IN PATIENTS WITH CHRONIC KIDNEY DISEASE HOSPITALIZED FOR HYPERKALEMIA

Yıl 2024, , 24 - 29, 17.01.2024

Onur Tunca , Sinan Kazan

https://doi.org/10.18229/kocatepetip.1156825

Öz

OBJECTIVE: Hyperkalemia is an electrolyte imbalance that can lead to fatal results if not corrected. Patients with chronic kidney disease are prone to be hyperkalemic. Knowing the factors associated with hospital mortality in patients hospitalized for hyperkalemia may reduce mortality caused by hyperkalemia. In the present study, we aimed to research the factors associated with hospital mortality in patients with chronic kidney disease hospitalized for hyperkalemia.
MATERIAL AND METHODS: Patients who were hospitalized in the nephrology clinic between January 2019 and April 2022 and whose serum potassium level was >5.1 mEq/L were included in the study. Patients were divided into two groups as in-hospital deaths and survivors. The groups were compared in terms of laboratory, clinical, and demographic characteristics.
RESULTS: The current study includes 123 cases with a diagnosis of chronic kidney disease. The mean age of the participants was 65.92±13.7 years. Age, diabetes mellitus, coronary artery disease, hemodialysis, potassium level, calcium and pH were found to be independent risk factors for mortality (p= 0.004, p< 0.001, p= 0.004, p=0.009, p=0.001, p=0.007,and p=0.008 respectively).
CONCLUSIONS: Poor outcomes can be reduced by knowing the factors affecting mortality in patients hospitalized for hyperkalemia. In hyperkalemic patients with increased in-hospital mortality risk, the mortality risk can be minimized with additional precautions and rapid intervention.

Anahtar Kelimeler

Diabetes mellitus, Hyperkalemia, Mortality, Age

HİPERKALEMİ NEDENİYLE HASTANEYE YATIRILAN KRONİK BÖBREK HASTALIĞI OLAN HASTALARDA HASTANE - İÇİ MORTALİTEYİ ETKİLEYEN FAKTÖRLER

Öz

AMAÇ: Hiperkalemi düzeltilmediği takdirde ölümcül sonuçlara yol açabilen bir elektrolit inbalansıdır. Kronik böbrek hastalığı olan hastalar hiperkalemik olma eğilimindedir. Hiperkalemi nedeniyle hastaneye yatırılan hastalarda hastane-içi mortalite ile ilişkili faktörleri bilmek hiperkaleminin sebep olduğu mortalitede azalma sağlayabilir. Bu çalışmada hiperkalemi nedeniyle hastaneye yatırılan kronik böbrek hastalığı olan hastalarda hastane-içi mortalite ile ilişkili faktörleri araştırmayı amaçladık.
GEREÇ VE YÖNTEM: Ocak 2019 - Nisan 2022 tarihleri arasında nefroloji kliniğine yatırılan ve serum potasyum düzeyi >5.1 mEq/L olan hastalar çalışmaya dahil edildi. Hastalar hastane-içi ölüm gelişen ve yaşayanlar olarak iki gruba ayrıldı. Gruplar laboratuvar, klinik ve demografik özellikler açısından karşılaştırıldı.
BULGULAR: Mevcut çalışma kronik böbrek hastalığı tanısı olan 123 hastayı içermektedir. Katılımcıların yaş ortalaması 65.92±13.7 yıldı. Yaş, diyabetes mellitus, koroner arter hastalığı, hemodiyaliz, potasyum seviyesi, kalsiyum ve pH mortalite açısından bağımsız birer risk faktörü olarak bulundu (sırasıyla p=0.004, p<0.001, p=0.004, p=0.009, p=0.001, p=0.007 ve p=0.008).
SONUÇ: Hiperkalemi nedeniyle hastaneye yatırılan hastalarda mortaliteyi etkileyen faktörlerin iyi bilinmesi ile kötü sonuçlar azaltılabilir. Hastane-içi mortalite riski artmış hiperkalemik hastalarda alınabilecek ek önlemler ve hızlı müdahale ile mortalite riski en aza indirilebilir.

Anahtar Kelimeler

Diyabetes mellitus, Hiperkalemi, Mortalite, Yaş

Kaynakça

• 1. Jain N, Kotla S, Little BB, et al. Predictors of hyperkalemia and death in patients with cardiac and renal disease. Am J Cardiol. 2012;109(10):1510-3.
• 2. Epstein M, Pitt B. Recent advances in pharmacological treatments of hyperkalemia: focus on patiromer. Expert Opin Pharmacother. 2016;17(10):1435-48.
• 3. Moranne O, Froissart M, Rossert J, et al. Timing of onset of CKD-related metabolic complications. J Am Soc Nephrol. 2009;20(1):164-71.
• 4. Kovesdy CP. Management of hyperkalaemia in chronic kidney disease. Nat Rev Nephrol. 2014;10(11):653-62.
• 5. Montford JR, Linas S. How Dangerous Is Hyperkalemia? J Am Soc Nephrol. 2017;28(11):3155-65.
• 6. Durfey N, Lehnhof B, Bergeson A, et al. Severe Hyperkalemia: Can the Electrocardiogram Risk Stratify for Short-term Adverse Events? West J Emerg Med. 2017;18(5):963-71.
• 7. Segura J, Ruilope LM. Hyperkalemia risk and treatment of heart failure. Heart Fail Clin. 2008;4(4):455-64.
• 8. Weisberg LS. Management of severe hyperkalemia. Crit Care Med. 2008;36(12):3246-51.
• 9. Paice B, Gray JM, McBride D, Donnelly T, Lawson DH. Hyperkalaemia in patients in hospital. Br Med J (Clin Res Ed). 1983;286(6372):1189-92.
• 10. Zhang J, He X, Wu J. The Impact of Hyperkalemia on Mortality and Healthcare Resource Utilization Among Patients With Chronic Kidney Disease: A Matched Cohort Study in China. Front Public Health. 2022;10:855395.
• 11. Thomsen RW, Nicolaisen SK, Hasvold P, et al. Elevated potassium levels in patients with chronic kidney disease: occurrence, risk factors and clinical outcomes-a Danish population-based cohort study. Nephrol Dial Transplant. 2018;33(9):1610-20.
• 12. Einhorn LM, Zhan M, Hsu VD, et al. The frequency of hyperkalemia and its significance in chronic kidney disease. Arch Intern Med. 2009;22;169(12):1156-62.
• 13. Piovezan RD, Oliveira D, Arias N, et al. Mortality Rates and Mortality Risk Factors in Older Adults with Dementia from Low- and Middle-Income Countries: The 10/66 Dementia Research Group Population-Based Cohort Study. J Alzheimers Dis. 2020;75(2):581-93.
• 14. Nomura Y, Shimada M, Kakuta E, et al. Mortality-and Health-Related Factors in a Community-Dwelling of Oldest-Older Adults at the Age of 90: A 10-Year Follow-Up Study. Int J Environ Res Public Health. 2020;17(24):9584.
• 15. Wu H, Le Couteur DG, Hilmer SN. Mortality trends of stroke and dementia: Changing landscapes and new challenges. J Am Geriatr Soc. 2021;69(10):2888-98.
• 16. Saeed F, Arrigain S, Schold JD, et al. What are the Risk Factors for One-Year Mortality in Older Patients with Chronic Kidney Disease? An Analysis of the Cleveland Clinic CKD Registry. Nephron. 2019;141(2):98-104.
• 17. Palaiodimos L, Chamorro-Pareja N, Karamanis D, et al. Diabetes is associated with increased risk for in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis comprising 18,506 patients. Hormones (Athens). 2021;20(2):305-14.
• 18. Figtree GA, Vernon ST, Hadziosmanovic N, et al. Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of SWEDEHEART registry data. Lancet. 2021;397(10279):1085-94.
• 19. Ma L, Zhao S. Risk factors for mortality in patients undergoing hemodialysis: A systematic review and meta-analysis. Int J Cardiol. 2017;238:151-58.
• 20. Salehidoost R, Mansouri A, Amini M, Aminorroaya Yamini S, Aminorroaya A. Diabetes and all-cause mortality, a 18-year follow-up study. Sci Rep. 2020;10(1):3183.
• 21. Afkarian M, Sachs MC, Kestenbaum B, et al. Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol. 2013;24(2):302-8.
• 22. Castro-Dominguez YS, Wang Y, Minges KE, et al. Predicting In-Hospital Mortality in Patients Undergoing Percutaneous Coronary Intervention. J Am Coll Cardiol. 2021;78(3):216-29.
• 23. Peterson PN, Rumsfeld JS, Liang L, et al. A validated risk score for in-hospital mortality in patients with heart failure from the American Heart Association get with the guidelines program. Circ Cardiovasc Qual Outcomes. 2010;3(1):25-32.
• 24. Thompson S, James M, Wiebe N, et al. Cause of Death in Patients with Reduced Kidney Function. J Am Soc Nephrol. 2015;26(10):2504-11.
• 25. Navaneethan SD, Schold JD, Arrigain S, et al. Cause-Specific Deaths in Non-Dialysis-Dependent CKD. J Am Soc Nephrol. 2015;26(10):2512-20.
• 26. Ma L, Zhao S. Risk factors for mortality in patients undergoing hemodialysis: A systematic review and meta-analysis. Int J Cardiol. 2017;238:151-58.
• 27. Li SH, Xie JT, Long HB, et al. Time-averaged serum potassium levels and its fluctuation associate with 5-year survival of peritoneal dialysis patients: two-center based study. Sci Rep. 2015;5:15743.
• 28. Braun HA, Van Horne R, Bettinger JC, et al. The influence of hypocalcemia induced by sodium ethylenediamine tetraacetate on the toxicity of potassium; an experimental study. J Lab Clin Med. 1955;46(4):544- 8.
• 29. Raikou VD. Metabolic acidosis status and mortality in patients on the end stage of renal disease. J Transl Int Med. 2016;4(4):170-77.
• 30. Tangri N, Reaven NL, Funk SE, et al. Metabolic acidosis is associated with increased risk of adverse kidney outcomes and mortality in patients with non-dialysis dependent chronic kidney disease: an observational cohort study. BMC Nephrol. 2021;22(1):185.