Solid organ transplant recipients who develop hyperkalemia have an increased risk of mortality and 30-day readmissions, according to results presented at ASN Kidney Week 2018.
Charuhas Thakar , MD, and colleagues classified peak potassium as normal (5 mEq/L), mild (5.1 mEq/L to 5.5 mEq/L), moderate (5.6 mEq/L to 6 mEq/L) or severe (greater than 6 mEq/L), with hyperkalemia defined as moderate or severe peak potassium groups, among patients with first hospitalization after transplant surgery or during the study period.
“The study examined all acute care hospitalizations in transplant recipients based on a national cohort,” Thakar, professor and director of the UC Division of Nephrology Kidney CARE Program at the UC College of Medicine and senior author of the study, told Healio.com/Nephrology. “The hospitalizations could have occurred for a variety of causes, including organ rejection, and we are analyzing the effect of specific cause of admission diagnoses on our primary and secondary outcomes.”
After adjustment for major confounders, researchers analyzed the effect of hyperkalemia and its severity on in-hospital mortality/hospice discharge and 30-day readmissions.
Among approximately 15,000 solid organ transplant recipients, results showed 16% experienced hyperkalemia. Researchers found an overall in-hospital mortality of 2.6%, with a mortality rate of 6.1% and 2% in patients with vs. without hyperkalemia, respectively. Patients with hyperkalemia experienced an increased risk of death and 30-day readmissions, according to results. Thakar noted the severity of hyperkalemia had a dose-response effect with the magnitude of mortality risk. Results showed a statistically significant synergistic interaction between hyperkalemia and type of solid organ transplant, with mortality risk most pronounced among liver transplant recipients, according to Thakar.
“Hyperkalemia can be underrecognized in this high-risk population, but our study shows that it is not uncommon and when it occurs, it has devastating consequences to the transplant recipients,” Thakar said.
He noted future research should examine specific predictors of hyperkalemia, such as prescriptions, and the development of additional models to predict mortality, including better assessments of severity of illness in solid organ transplant patients.
“Most importantly, we would like to address the question as to whether hyperkalemia is truly a therapeutic target to improve morbidity and mortality in hospitalized transplant recipients,” Thakar said. – by Casey Tingle
Yamada M, et al. Abstract SA-OR034. Presented at: ASN Kidney Week; San Diego; Oct. 23-28, 2018.
Disclosure: Thakar reports that part of the research was supported by a fellowship grant award funded by Relypsa.