Hyperkalemia Recurrence and Its Association With Race and Ethnicity in United States Veterans: A Retrospective Cohort Study

Rebecca S Ahdoot; Jui-Ting Hsiung; Abiy Agiro; Yasmin G Brahmbhatt; Kerry Cooper; Souhiela Fawaz; Laura Westfall; Keith C Norris; Kamyar Kalantar-Zadeh; Elani Streja

doi:10.7759/cureus.59003

Hyperkalemia Recurrence and Its Association With Race and Ethnicity in United States Veterans: A Retrospective Cohort Study

Cureus. 2024 Apr 25;16(4):e59003. doi: 10.7759/cureus.59003. eCollection 2024 Apr.

Authors

Rebecca S Ahdoot¹, Jui-Ting Hsiung^{1

2}, Abiy Agiro³, Yasmin G Brahmbhatt³, Kerry Cooper³, Souhiela Fawaz³, Laura Westfall³, Keith C Norris⁴, Kamyar Kalantar-Zadeh^{2

5}, Elani Streja^{1

2}

Affiliations

¹ Department of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, USA.
² Department of Research, Tibor Rubin VA Medical Center, Long Beach, USA.
³ Department of Medical Affairs, AstraZeneca, Wilmington, USA.
⁴ Department of Medicine, University of California Los Angeles, Los Angeles, USA.
⁵ Department of Medicine, Harbor-UCLA Medical Center, Torrance, USA.

Abstract

Introduction: Information on whether race and ethnicity are associated with a greater risk of recurrent hyperkalemia is limited. The aim of this study was to examine the association between race or ethnicity and recurrent hyperkalemia in a population of US veterans.

Methods: This retrospective study used the US Veterans Affairs database to identify adults (aged ≥18 years) with at least one serum potassium measurement during the study period who ever experienced hyperkalemia (serum potassium > 5.0 mmol/L). The proportion of patients with hyperkalemia recurrence (≥1 subsequent event) within one year was determined for different race and ethnicity groups. The association between patient race and ethnicity and the risk of hyperkalemia recurrence within one year after the index hyperkalemia event was analyzed using competing risk regression.

Results: Among a total of 1,493,539 veterans with incident hyperkalemia (median age (interquartile range): 61.0 years (54.0, 71.0)), recurrence within one year occurred in 19.1% of Black, 16.0% of Native Hawaiian/other Pacific Islander, 15.1% of White, 14.9% of American Indian/Alaska Native, and 13.1% of Asian patient groups. Recurrent hyperkalemia occurred in 18.1% of Hispanic and 15.6% of non-Hispanic patient groups. In a fully-adjusted regression model, recurrent hyperkalemia risk was significantly higher in Black versus White patient groups (subhazard ratio (sHR), 1.17; 95% confidence interval (CI), 1.16-1.19; p< 0.0001) and in Hispanic versus non-Hispanic patient groups (sHR, 1.30; 95% CI, 1.28-1.33; p< 0.0001).

Discussion/conclusion: Among US veterans with incident hyperkalemia, the risk of recurrent hyperkalemia was higher in Black and Hispanic patient groups. This information may be useful for health system screenings to risk stratify patient groups and both guide the frequency of serum potassium monitoring and better understand the root causes of group differences.

Keywords: black; ethnicity; hispanic; hyperkalemia; outcomes; potassium; race; recurrence; retrospective study; risk factors.

Grants and funding

The study was supported by AstraZeneca. AstraZeneca funded the study and manuscript development (medical writing and publication fees) and was not involved in data collection or analysis. Authors who were employees of AstraZeneca participated in the study conceptualization/design and interpretation of data. Authors who were employees of AstraZeneca participated in drafting and critical review of the manuscript, which also underwent AstraZeneca medical/legal review prior to submission. The non-AstraZeneca authors take sole accountability for data collection and analysis. The final decision to submit the manuscript for publication was the shared responsibility of all authors, and the content of the manuscript does not reflect the positions of either the US Department of Veterans Affairs or AstraZeneca.