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

R W Thomsen, S K Nicolaisen, K Adelborg, E Svensson, P Hasvold, E Palaka, L Pedersen, H T Sørensen

REVIEW


09 August 2018

I don’t think that this paper adds much to what we already know about hyperkalaemia in patients. The conclusions are somewhat misleading by pointing to diabetes as being the problem, rather than the other known risk factors for hyperkalaemia such as ACE-inhibitors, heart failure and spironolactone (for heart failure). I have given the paper a higher clinical applicability rating because monitoring potassium levels is so important for patients with newly-diagnosed diabetes.


RELEVANCE 1
INNOVATIVENESS 2
APPLICABILITY 4
OVERALL 2

PAPER DETAILS


TITLE

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

ABSTRACT

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.



AUTHOR(S)

R W Thomsen, S K Nicolaisen, K Adelborg, E Svensson, P Hasvold, E Palaka, L Pedersen, H T Sørensen,

JOURNAL

Diabetic medicine : a journal of the British Diabetic Association

PLACE

England