Epidemiology

​Hyperkalemia is one of the most commonly occurring acute electrolyte abnormalities, with estimated incidence rates of between 1% and 10% of all hospitalized patients, and up to 3% of patients who attend the emergency department.[6]​ Studies estimate that hyperkalemia contributes to around 800,000 visits to the emergency department in the US per year.[6][7]

The prevalence of hyperkalemia is increasing due to the continued increase in numbers of the aging population as well as the rise in associated comorbidities within the general and aging population.[2]​ Retrospective studies have shown that in-hospital mortality is significantly higher in patients with hyperkalemia (18.1%) compared with those with hypokalemia (5.0%) or normokalemia (3.9%).[8]

Key risk factors for hyperkalemia include kidney dysfunction (particularly end-stage kidney disease) including those receiving dialysis who are fasting or have missed dialysis; use of renin-angiotensin-aldosterone system inhibitors (RAASi), aldosterone antagonists, or trimethoprim; diabetes mellitus; heart failure; liver disease; tissue breakdown (e.g., rhabdomyolysis, trauma, tumor lysis syndrome, and severe hypothermia); and distal renal tubule defects that affect potassium excretion. A large systematic review and meta-analysis of 542 articles reviewing the epidemiology of hyperkalemia within the general population, across different continents, and in different healthcare settings showed the prevalence of hyperkalemia of any severity to be greater than 20% in patients receiving dialysis, those with a kidney transplant, and patients with acute kidney injury, compared with less than 3% in the general population.[9]​ The same review found increased prevalence of hyperkalemia in patients on RAASi (5.8%, 95% CI 5.1% to 6.6%) and aldosterone antagonists (8.9%, 95% CI 7.2% to 11.0%) compared with the general population (2.3%, 95% CI 1.9% to 2.8%). Use of dual ACE inhibitor/angiotensin-II receptor antagonist and aldosterone antagonist therapy was associated with an even higher prevalence of 14.6% (95% CI 9.6% to 22.0%).[9]​ Another study revealed that more than half of all patients in predialysis with chronic kidney disease developed hyperkalemia.[10]​ In a further study of 650 patients with acute-on-chronic liver failure, 12.2% had an episode of hyperkalemia during hospitalization.[11]

In the UK, hyperkalemia has been shown to affect almost 10% of patients in the community within 1 year of starting RAASi, in many cases leading to limiting treatment in the patients who are most likely to receive benefit from these drugs.[1]

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