Prognosis

​Clinical consequences of hyperkalaemia include both a direct effect on clinical outcomes by causing possible fatal arrhythmias in the acute setting, as well as being a cause of discontinuation or down titration of drugs used in the management of heart failure, which may indirectly affect clinical outcomes.[92]

One retrospective study found that in-hospital mortality was significantly higher in patients with hyperkalaemia (18.1%) compared with those with hypokalaemia (5.0%) or normokalaemia (3.9%).[8]​ Another retrospective analysis of 245,808 patients in the US found an odds ratio for death of 33.4 among inpatients without chronic kidney disease (CKD) and of 15.8 in CKD inpatients within 1 day of an inpatient serum potassium ≥6 mmol/L (≥6 mEq/L) compared with no hyperkalaemia (serum potassium <5.5 mmol/L [<5.5 mEq/L]).[93]

Hospitalised patients with hyperkalaemia

Several studies have shown an association between hyperkalaemia in hospitalised patients and all-cause mortality.[72][94][95]​​​ Patients with severe hyperkalaemia (serum potassium ≥6.5 mmol/L [≥6.5 mEq/L]) have the highest risk, and in one report, in-hospital mortality in this group was 30.7%.[72]​ It is still unclear whether increased mortality levels are directly caused by hyperkalaemia or if the condition is more a marker of illness severity.[12]

Duration of hyperkalaemia, hyperkalaemia due to potassium supplementation, tissue necrosis, metabolic acidosis, calcium therapy, and presence of acute kidney injury are some of the factors that are thought to be independent predictors of in-hospital mortality in hyperkalaemic patients who have been hospitalised.[12][73]​

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