Solid organ transplant (SOT) recipients experience an increased incidence of hyperkalemia—higher-than-normal potassium levels in the blood—caused by both pathophysiological or medication-related mechanisms, according to a study by researchers from the University of Cincinnati (UC) Division of Nephrology Kidney CARE Program. The research was presented at the American Society of Nephrology meeting in San Diego, Oct. 27, 2018.

"Hyperkalemia is common in transplant recipients admitted to acute care, and can be potentially devastating to the patients,” says Charuhas Thakar, MD, professor and director of the UC Division of Nephrology Kidney CARE Program at the UC College of Medicine and senior author of the study. "The risk of hyperkalemia has been well-recognized in the past. However, our study is among the largest studies in SOT recipients to investigate the incidence and outcomes associated with this abnormality.”

In a multicenter sample of approximately 15,000 SOT recipients, the investigators examined the incidence and outcomes of hyperkalemia. Specifically, they examined first hospitalizations after transplant surgery. This is among the largest studies of SOT recipients across multiple centers in the United States, with 64.7% being kidney transplant patients, 17.2% liver, 8% heart patients, and 10.1% being other SOT recipients.

Overall, 16% experienced moderate to severe hyperkalemia, defined as potassium levels above 5.5 milliequivalents per liter. Compared to the mortality of 2% in patients without hyperkalemia, mortality was 6% in those with hyperkalemia. Hyperkalemia also increased the risk of 30-day readmissions.

"There are limitations to this study,” says Thakar. "Observational studies and associations can have unmeasured confounders, and future studies need to identify specific modifiable factors that can mitigate the risks of this rather common electrolyte disorder. Additionally, efforts should be made to prevent patient harm from this potentially treatable condition.”