Hyperkalemia Management with Intravenous Insulin in Patients with Reduced Kidney Function
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Setting, Subjects, and Ethical Approval
2.2. Data Collection and Management
2.3. Study Outcomes
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics of Study Subjects
3.2. Standard Management of Hyperkalemia
3.3. Hypoglycemia and Other Outcomes for Hyperkalemia Management
3.4. Risk Factors Associated with Hypoglycemia
3.5. Sub-Analysis for Patients Who Received a Second Dose of Insulin
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic or Variable | Overall | Hemodialysis | p-Value * | |
---|---|---|---|---|
Non-Dependent | Dependent | |||
Number of patients | 172 | 97 | 75 | --- |
Age, years | 65.2 ± 15.1 | 68.1 ± 13.6 | 61.3 ± 16.1 | 0.003 |
Sex | 0.878 | |||
Male | 86 (50.0) | 48 (49.5) | 38 (50.7) | |
Female | 86 (50.0) | 49 (50.5) | 37 (49.3) | |
Body mass index (BMI), kg/m2 | 28.4 ± 8.5 | 29.5 ± 8.8 | 27.0 ± 7.8 | 0.050 |
Comorbid conditions | ||||
Diabetes mellitus | 129 (75.0) | 78 (80.4) | 51 (68.0) | 0.062 |
Hypertension | 146 (84.9) | 81 (83.5) | 65 (86.7) | 0.566 |
Heart failure | 37 (21.5) | 27 (27.8) | 10 (13.3) | 0.022 |
Ischemic heart disease | 27 (15.7) | 12 (12.4) | 15 (20.0) | 0.173 |
Laboratory values at admission | ||||
Blood glucose, mmol/L | 11.3 ± 8.8 | 12.1 ± 9.8 | 10.3 ± 7.1 | 0.189 |
Serum creatinine, umol/L | 329.0 ± 258.7 | 146.4 ± 94.0 | 565 ± 207.5 | <0.001 |
Potassium, mmol/L | 6.6 ± 0.7 | 6.5 ± 0.5 | 6.7 ± 0.8 | 0.049 |
Home medications that may cause hyperkalemia | ||||
β-Blockers | 75 (43.6) | 38 (39.2) | 37 (49.3) | 0.183 |
ACE-Is | 25 (14.5) | 21 (21.6) | 4 (5.3) | 0.003 |
ARBs | 23 (13.4) | 21 (21.6) | 2 (2.7) | <0.001 |
Potassium-sparing diuretics | 15 (8.7) | 13 (13.4) | 2 (2.7) | 0.013 |
Characteristic or Variable | Overall | Hemodialysis | p-Value * | |
---|---|---|---|---|
Non-Dependent | Dependent | |||
Number of patients | 172 | 97 | 75 | |
β-agonist | 144 (83.7) | 83 (85.6) | 61 (81.3) | 0.456 |
Calcium | 92 (53.5) | 52 (53.6) | 40 (53.3) | 0.971 |
Sodium bicarbonate | 51 (29.7) | 41 (42.3) | 10 (13.3) | <0.001 |
Diuretics | 34 (19.8) | 30 (30.9) | 4 (5.3) | <0.001 |
Dialysis | 32 (18.6) | 4 (4.1) | 28 (37.3) | <0.001 |
Characteristic or Variable | Overall | Hemodialysis | p-Value * | |
---|---|---|---|---|
Non-Dependent | Dependent | |||
Hypoglycemia after insulin administration | 31 (18.0) | 16 (16.5) | 15 (20.0) | 0.553 |
All-cause ICU admission | 26 (15.1) | 21 (21.6) | 5 (6.7) | 0.006 |
Readmission within one-month with hyperkalemia | 9 (5.2) | 2 (2.1) | 7 (9.3) | 0.042 |
All-cause readmission within one month | 30 (17.4) | 17 (17.5) | 13 (17.3) | 0.974 |
Variables | Category | Hypoglycemia | OR (95% CI) * | AOR (95% CI) ** | |
---|---|---|---|---|---|
No | Yes | ||||
Number of patients | 141 (82.0) | 31 (18.0) | --- | ------ | |
Hemodialysis group | |||||
Non-dependent | 81 (83.5) | 16 (16.5) | Ref | ------ | |
Dependent | 60 (80.0) | 15 (20.0) | 1.26 (0.58–2.76) | ------ | |
Age, years | 64.3 ± 15.7 | 68.9 ± 11.3 | 1.02 (0.99–1.05) | 1.04 (1.01–1.08) | |
Sex | Female | 68 (79.1) | 18 (20.9) | Ref | ------ |
Male | 73 (84.9) | 13 (15.1) | 0.67 (0.30–1.48) | ------ | |
BMI, kg/m2 | 28.4 ± 8.9 | 28.5 ± 5.7 | 1.00 (0.95–1.05) | ------ | |
Comorbid conditions | |||||
Diabetes mellitus | No | 35 (81.4) | 8 (18.6) | Ref | ------ |
Yes | 106 (82.20 | 23 (17.8) | 0.94 (0.39–2.31) | ------ | |
Hypertension | No | 23 (88.5) | 3 (11.5) | Ref | ------ |
Yes | 118 (80.8) | 28 (19.2) | 1.82 (0.51–6.48) | ------ | |
Heart failure | No | 115 (85.2) | 20 (14.8) | Ref | Ref |
Yes | 26 (70.3) | 11 (29.7) | 2.43 (1.03–5.69) | 3.92 (1.14–10.9) | |
Ischemic Heart Disease | No | 118 (81.4) | 27 (18.6) | Ref | ------ |
Yes | 23 (85.2) | 4 (14.8) | 0.76 (0.24–2.38) | 0.39 (0.10–1.57) | |
Laboratory values at admission | |||||
Blood glucose, mmol/L | 11.7 ± 9.4 | 9.7 ± 4.9 | 0.97 (0.92–1.02) | 0.96 (0.89–1.02) | |
Serum creatinine, umol/L | 314.7 ± 249.4 | 393.7 ± 293.4 | 1.00 (1.00–1.00) | 1.003 (1.001–1.010) | |
Potassium, mmol/L | 6.5 ± 0.7 | 6.5 ± 0.7 | 0.98 (0.55–1.73) | ------ | |
Drugs that may cause hyperkalemia | |||||
β-Blockers | No | 82 (84.5) | 15 (15.5) | Ref | ------ |
Yes | 59 (78.7) | 16 (21.3) | 1.48 (0.68–3.23) | ------ | |
ACE-Is | No | 120 (81.6) | 27 (18.4) | Ref | ------ |
Yes | 21 (84.0) | 4 (16.0) | 0.84 (0.27–2.67) | ------ | |
ARBs | No | 122 (81.9) | 27 (18.1) | Ref | ------ |
Yes | 19 (82.6) | 4 (17.4) | 0.95 (0.29–3.02) | ------ | |
Potassium-sparing diuretic | No | 128 (81.5) | 29 (18.5) | Ref | ------ |
Yes | 13 (86.7) | 2 (13.3) | 0.68 (0.14–3.17) | ------ | |
Intervention | |||||
Calcium | No | 66 (82.5) | 14 (17.5) | Ref | ------ |
Yes | 75 (81.5) | 17 (18.5) | 1.06 (0.49–2.33) | ------ | |
β-agonist | No | 24 (85.7) | 4 (14.3) | Ref | ------ |
Yes | 117 (81.2) | 27 (18.8) | 1.38 (0.44–4.32) | ------ | |
Sodium bicarbonate | No | 100 (82.6) | 21 (17.4) | Ref | ------ |
Yes | 41 (80.4) | 10 (19.6) | 1.16 (0.50–2.68) | ------ | |
Diuretics | No | 113 (81.9) | 25 (18.1) | Ref | ------ |
Yes | 28 (82.4) | 6 (17.6) | 0.97 (0.36–2.59) | ------ | |
Dialysis | No | 119 (85.0) | 21 (15.0) | Ref | ------ |
Yes | 22 (68.7) | 10 (31.3) | 2.58 (1.07–6.21) | ------ | |
Receiving a second dose of insulin | No | 89 (89.0) | 11 (11.0) | Ref | Ref |
Yes | 52 (72.2) | 31 (27.8) | 3.11 (1.38–7.00) | 4.14 (1.68–10.21) |
Variable and Time of Follow-Up | Overall | One Dose of Insulin | Two Doses of Insulin | p-Value * | ||
---|---|---|---|---|---|---|
Hemodialysis Non-Dependent | Hemodialysis Dependent | Hemodialysis Non-Dependent | Hemodialysis Dependent | |||
Number of patients who received | 0.021 | |||||
One dose of insulin | 100/172 (58.1) | 49/97 (50.5) | 51/75 (68.0) | --- | --- | |
Two doses of insulin | 72/172 (41.9) | --- | --- | 48/97 (49.5) | 24/75 (32.0) | |
Dose of the repeated insulin | 0.597 | |||||
Standard dose (10 units) | 68/72 (94.4) | --- | --- | 46/48 (95.8) | 22/24 (91.7) | |
Other doses (Less than 10 units) | 4/72 (5.6) | --- | --- | 2/48 (4.2) | 2/24 (8.3) | |
The mean of blood glucose | ||||||
On admission | 11.3 ± 8.8 | 12.3 ± 10.3 | 10.0 ± 6.8 | 11.9 ± 9.4 | 10.9 ± 7.8 | 0.662 |
From 2–4 h from admission | 14.4 ± 12.1 | 18.1 ± 14.8 | 10.7 ± 7.0 | 16.0 ± 14.6 | 11.4 ± 7.9 | 0.453 |
From 6–8 h | 11.4 ± 7.3 | 12.4 ± 9 | 11.6 ± 7.4 | 11.8 ± 6.5 | 7.7 ± 2.6 | 0.010 |
From 8–12 h | 10.5 ± 6.4 | 11.1 ± 4.9 | 10.9 ± 8.4 | 10.4 ± 5.5 | 8.9 ± 7.4 | 0.548 |
From 12–24 h | 9.3 ± 5.5 | 10.1 ± 6.0 | 7.1 ± 4.5 | 11.2 ± 5.9 | 7.2 ± 2.8 | <0.001 |
Day 2 | 8.9 ± 4.5 | 8.9 ± 3.8 | 7.1 ± 3.9 | 10.8 ± 4.6 | 9.2 ± 5.9 | 0.243 |
Day 3 | 8.8 ± 4.9 | 9.1 ± 4.1 | 7.2 ± 4.6 | 10.1 ± 5.3 | 8.9 ± 5.9 | 0.449 |
The mean potassium level | ||||||
On admission | 6.6 ± 0.7 | 6.4 ± 0.6 | 6.6 ± 0.8 | 6.5 ± 0.5 | 6.8 ± 1.0 | 0.138 |
Within 6 h | 5.6 ± 0.8 | 5.4 ± 0.8 | 5.3 ± 0.6 | 5.9 ± 0.5 | 6.0 ± 1.0 | 0.735 |
From 6–12 h | 5.4 ± 0.9 | 5.0 ± 0.8 | 4.8 ± 1.0 | 5.9 ± 0.8 | 5.7 ± 0.6 | 0.371 |
From 12–24 h | 5.2 ± 0.8 | 4.8 ± 0.8 | 5.1 ± 0.8 | 5.5 ± 0.7 | 5.7 ± 0.8 | 0.366 |
Day 2 | 4.7 ± 0.6 | 4.4 ± 0.6 | 4.7 ± 0.6 | 4.8 ± 0.6 | 4.9 ± 0.7 | 0.311 |
Variable/Time of Follow-Up | Overall | Hemodialysis | |||
---|---|---|---|---|---|
Non-Dependent | Dependent | ||||
One Dose | Two Doses | One Dose | Two Doses | ||
Serum Creatinine, umol/L | |||||
Baseline | 329.0 ± 258.7 | 151.8 ± 89.4 | 141.0 ± 99.1 | 583.1 ± 220.4 | 526.7 ± 175.3 |
On admission | 533.3 ± 351.4 | 305.9 ± 172.0 | 273.0 ± 133.4 | 865.1 ± 289.6 | 813.0 ± 245.8 |
Day 1 | 449.8 ± 297.3 | 269.8 ± 155.1 | 250.0 ± 132.8 | 684.9 ± 271.2 | 719.8 ± 244.9 |
Day 2 | 405.5 ± 279.3 | 236.2 ± 136.1 | 230.8 ± 125.0 | 657.3 ± 254.0 | 646.8 ± 242.6 |
Day 3 | 384.0 ± 273.1 | 217.0 ± 142.1 | 218.0 ± 124.1 | 614.3 ± 280.0 | 581.6 ± 191.1 |
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Alzahrani, M.A.; AlAbdan, N.A.; Alahmari, Z.S.; Alshehri, N.M.; Alotaibi, L.H.; Almohammed, O.A. Hyperkalemia Management with Intravenous Insulin in Patients with Reduced Kidney Function. J. Clin. Med. 2024, 13, 5103. https://doi.org/10.3390/jcm13175103
Alzahrani MA, AlAbdan NA, Alahmari ZS, Alshehri NM, Alotaibi LH, Almohammed OA. Hyperkalemia Management with Intravenous Insulin in Patients with Reduced Kidney Function. Journal of Clinical Medicine. 2024; 13(17):5103. https://doi.org/10.3390/jcm13175103
Chicago/Turabian StyleAlzahrani, Maram A., Numan A. AlAbdan, Zainab S. Alahmari, Nouf M. Alshehri, Lama H. Alotaibi, and Omar A. Almohammed. 2024. "Hyperkalemia Management with Intravenous Insulin in Patients with Reduced Kidney Function" Journal of Clinical Medicine 13, no. 17: 5103. https://doi.org/10.3390/jcm13175103