Prognosis

​Clinical consequences of hyperkalemia 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.[93]

One retrospective study found that in-hospital mortality was significantly higher in patients with hyperkalemia (18.1%) compared with those with hypokalemia (5.0%) or normokalemia (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 mEq/L (≥6 mmol/L) compared with no hyperkalemia (serum potassium <5.5 mEq/L [<5.5 mmol/]).[94]

Hospitalized patients with hyperkalemia

Several studies have shown an association between hyperkalemia in hospitalized patients and all-cause mortality.[72][95][96]​​​ Patients with severe hyperkalemia (serum potassium ≥6.5 mEq/L [≥6.5 mmol/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 hyperkalemia or if the condition is more a marker of illness severity.[12]

Duration of hyperkalemia, hyperkalemia 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 hyperkalemic patients who have been hospitalized.[12][73]​

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