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Article

Liver Disease Is a Risk Factor for Recurrent Hyperkalemia: A Retrospective Cohort Study

by
Rebecca S. Ahdoot
1,†,
Jui-Ting Hsiung
1,2,†,
Abiy Agiro
3,
Yasmin G. Brahmbhatt
4,‡,
Kerry Cooper
4,‡,
Souhiela Fawaz
4,
Laura Westfall
4,
Kamyar Kalantar-Zadeh
2,5 and
Elani Streja
1,2,*
1
Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, University of California Irvine, Irvine, CA 92868, USA
2
Veterans Affairs Long Beach Healthcare System, 5901 East 7th Street, Long Beach, CA 90822, USA
3
AstraZeneca, US Evidence, US Medical Affairs, Wilmington, DE 19803, USA
4
AstraZeneca, US Renal, US Medical Affairs, Wilmington, DE 19803, USA
5
Harbor UCLA Medical Center, Nephrology, University of California Los Angeles, Los Angeles, CA 90502, USA
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
‡
At the time of the study.
J. Clin. Med. 2023, 12(14), 4562; https://doi.org/10.3390/jcm12144562
Submission received: 10 May 2023 / Revised: 21 June 2023 / Accepted: 27 June 2023 / Published: 8 July 2023
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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Abstract

Liver disease is often associated with dysfunctional potassium homeostasis but is not a well-established risk factor for hyperkalemia. This retrospective cohort study examined the potential relationship between liver disease and recurrent hyperkalemia. Patients with ≥1 serum potassium measurement between January 2004 and December 2018 who experienced hyperkalemia (serum potassium >5.0 mmol/L) were identified from the United States Veterans Affairs database. A competing risk regression model was used to analyze the relationship between patient characteristics and recurrent hyperkalemia. Of 1,493,539 patients with incident hyperkalemia, 71,790 (4.8%) had liver disease (one inpatient or two outpatient records) within 1 year before the index hyperkalemia event. Recurrent hyperkalemia within 1 year after the index event occurred in 234,807 patients (15.7%) overall, 19,518 (27.2%) with liver disease, and 215,289 (15.1%) without liver disease. The risk of recurrent hyperkalemia was significantly increased in patients with liver disease versus those without (subhazard ratio, 1.34; 95% confidence interval, 1.32–1.37; p < 0.0001). Aside from vasodilator therapy, the risk of recurrent hyperkalemia was not increased with concomitant medication. In this cohort study, liver disease was an independent risk factor strongly associated with recurrent hyperkalemia within 1 year, independent of concomitant renin–angiotensin–aldosterone system inhibitor or potassium-sparing diuretic use.
Keywords: cirrhosis; electrolyte imbalance; hyperkalemia; kidney disease; liver disease; potassium; retrospective study; recurrence cirrhosis; electrolyte imbalance; hyperkalemia; kidney disease; liver disease; potassium; retrospective study; recurrence

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MDPI and ACS Style

Ahdoot, R.S.; Hsiung, J.-T.; Agiro, A.; Brahmbhatt, Y.G.; Cooper, K.; Fawaz, S.; Westfall, L.; Kalantar-Zadeh, K.; Streja, E. Liver Disease Is a Risk Factor for Recurrent Hyperkalemia: A Retrospective Cohort Study. J. Clin. Med. 2023, 12, 4562. https://doi.org/10.3390/jcm12144562

AMA Style

Ahdoot RS, Hsiung J-T, Agiro A, Brahmbhatt YG, Cooper K, Fawaz S, Westfall L, Kalantar-Zadeh K, Streja E. Liver Disease Is a Risk Factor for Recurrent Hyperkalemia: A Retrospective Cohort Study. Journal of Clinical Medicine. 2023; 12(14):4562. https://doi.org/10.3390/jcm12144562

Chicago/Turabian Style

Ahdoot, Rebecca S., Jui-Ting Hsiung, Abiy Agiro, Yasmin G. Brahmbhatt, Kerry Cooper, Souhiela Fawaz, Laura Westfall, Kamyar Kalantar-Zadeh, and Elani Streja. 2023. "Liver Disease Is a Risk Factor for Recurrent Hyperkalemia: A Retrospective Cohort Study" Journal of Clinical Medicine 12, no. 14: 4562. https://doi.org/10.3390/jcm12144562

APA Style

Ahdoot, R. S., Hsiung, J.-T., Agiro, A., Brahmbhatt, Y. G., Cooper, K., Fawaz, S., Westfall, L., Kalantar-Zadeh, K., & Streja, E. (2023). Liver Disease Is a Risk Factor for Recurrent Hyperkalemia: A Retrospective Cohort Study. Journal of Clinical Medicine, 12(14), 4562. https://doi.org/10.3390/jcm12144562

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