Hyperkalemia and the Risks of Adverse Cardiovascular Outcomes in Patients With Chronic Kidney Disease

Background This real-world evidence study compared risks of cardiovascular events in hospital settings among patients with chronic kidney disease (CKD) with and without hyperkalemia. Methods and Results Adults with CKD stages 3b/4 with and without hyperkalemia were identified from Optum's deidentified Market Clarity Data (January 2016-August 2022). Patients with hyperkalemia were exact and propensity score matched to patients without hyperkalemia. The index date was the first CKD stage 3b/4 diagnosis with >= 1 hyperkalemia diagnosis and >= 1 serum potassium >5.0 mmol/L in the preceding 12 months (baseline) for patients with hyperkalemia and a randomly selected CKD stage 3b/4 diagnosis for controls. Cardiovascular composite end points included major adverse cardiovascular events plus (a composite end point of all-cause mortality, myocardial infarction, stroke, or heart failure) and cardiac arrhythmias (a composite end point of new onset atrial fibrillation and other atrial and ventricular arrythmias), all in the hospital setting. We compared cardiovascular events between cohorts using cause-specific Cox proportional hazards regression. The study included 5301 matched pairs in the analysis of major adverse cardiovascular events plus and 5564 in the analysis of arrhythmia. Cardiovascular events were more likely among patients with hyperkalemia relative to those without hyperkalemia, with the risk of major adverse cardiovascular events plus increased by 32% (23%-40%) and the risk of arrhythmia increased by 59% (44%-75%; both P<0.001). Conclusions Among patients with CKD stages 3b/4, patients with hyperkalemia experienced significantly higher risks of major adverse cardiovascular events and arrhythmia in hospital settings relative to patients without hyperkalemia.