Many ER Patients with Elevated Potassium, End up Being Admitted After Discharge Interview with:
AstraZenecaJill Davis, MS
Director, Health Economics and Outcomes Research
AstraZeneca What is the background for this study? Who is most at risk for hyperkalemia post discharge?

Response: In the United States, an estimated 30 million people suffer from chronic kidney disease (CKD), about 3.7 million of which have hyperkalemia (elevated potassium level). Hyperkalemia (HK) can be chronic, so it’s important that those who have been diagnosed with hyperkalemia previously or have CKD have their potassium levels monitored by their healthcare provider. Additionally, although HK is estimated to be prevalent in more than 66,000 emergency department (ED) visits annually, there is limited knowledge about the management of patients with HK in the ED setting and post-discharge. We decided to focus our study to better understand and compare the ED management and post-discharge outcomes among patients with varying levels of hyperkalemia

To conduct this study, we analyzed the electronic medical record data from the Research Action for Health Network (2012-2018) of 6,222 adult patients with a randomly selected HK-related ED visit. We concluded that improved management of HK patients in the ED and post-discharge period is needed to reduce the recurrence of hyperkalemia. What are the main findings?

Response: From the over 6,000 patients included in the analysis, one of the most compelling findings was that within 30 days after ED discharge, hyperkalemia recurred in 12.9% of patients with mild hyperkalemia, 19% of patients with moderate HK and 32.5% of patients with severe HK. Additionally, our research showed that only 0.3% of mild HK patients, 1.9% of moderate HK patients and 5.2% of severe HK patients received potassium-binding treatment at discharge. These findings present a gap and need to treat more patients at discharge and continue to treat these patients post-initial discharge to reduce the rate of recurrence.

Additionally, we found that after an hyperkalemia-related ED visit, 5.8% with mild HK, 8.7% with moderate HK and 12.7% with severe HK were immediately admitted to inpatient (IP) care on the same day as ED discharge. More generally, our data showed that within 90 days of discharge, approximately one quarter of patients across hyperkalemia severities were admitted to an IP facility. Ultimately these findings present the need to better manage ED visits and post-discharge outcomes, with the overall goal to reduce rates of recurred HK, What should readers take away from your report?

Response: We are committed to improving our understanding of the management of HK in the ED setting and resulting outcomes following discharge. This improved knowledge can be used to inform future research and treatment management.

The findings emphasize the need for continued research into the treatment management of hyperkalemia. By improving knowledge on current HK patients’ experiences, especially in the ED setting and outcomes following discharge, we can determine underlying patterns and as a result help inform future research insights. What recommendations do you have for future research as a result of this work?

Response: In a space where the unmet need remains high, we are committed to future research opportunities to improve the health outcomes of patients living with hyperkalemia. We recommend continued dedication to similar investigations, that not only evaluate medications, but strive to improve practices surrounding the treatment management of HK patients in the ED setting and upon discharge. 

Disclosures: I am an employee of AstraZeneca, which sponsored the study. 


NKF Spring 2018 abstract:

Management, Post-discharge Admission, and Recurrence among Hyperkalemic Patients in the Emergency Department Setting

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Last Updated on June 4, 2019 by Marie Benz MD FAAD