Abstract
Background and Aims
At present, the clinical burden and treatment pattern of hyperkalaemia among outpatients in China is not well characterized. The aim of this study was to evaluate the disease distribution and treatment pattern of hyperkalaemia among outpatients in China.
Method
Data were derived from Beijing Data Center for Rational Use of Drugs, which contains primary records of 157 hospitals, covering 30 provinces in China. Patients who accessed outpatients (aged >=≥18 years old) with record(s) of serum potassium (S-K) between 2015.1.1- 2017.12.31 were included. The laboratory test, diagnoses, and treatments were analyzed. Hyperkalaemia defined as S-K > 5.0 mmol/L. A hyperkalaemia episode was defined as one or more consecutive S-K > 5.0mmol/L measurement(s) within 7 days. If there was a return to S-K <5.0mmol/L within 7 days, the subsequent measurement(s) will be recognized as another hyperkalaemia episode. The proportion of hyperkalaemia was defined as the proportion of patients who experienced at least one hyperkalaemia episode. The main outcomes, including the proportion of hyperkalaemia patients, the diagnosis rate, the treatment rate and the S-K retesting rate were analyzed. The geographic and seasonal distribution of the proportion was examined. The diagnosis rate was defined as the proportion of hyperkalaemia episodes that have diagnoses records of hyperkalaemia within the episode. Treatment rate was defined as the proportion of hyperkalaemia episodes that have records of any hyperkalaemia treatment including diuretics, glucose injection + insulin, calcium injection, sodium bicarbonate, potassium binder, transfer to emergency room or dialysis. Retesting rate was defined as the proportion of hyperkalaemia records that have potassium test record(s) within one day, two days or seven days.
Results
A total of 2,997,634 patients with at least one S-K record each were analysed. 115,826 patient (3.86%) experienced hyperkalaemia (S-K >5.0mmol/L), in which 28,254 patients (0.94%), experienced S-K ≥5.5mmol/L. In patients with chronic kidney disease, heart failure, hypertension, and diabetes mellitus, the proportions of patients who experienced hyperkalaemia were 22.89%, 12.54%, 7.11% and 6.51%, respectively. Composition proportion of who experienced S-K ≥ 5.5mmol/L, in the patients with CKD and HF, defined as the proportion of patients experienced S-K≥ 5.5mmol/L in all hyperkalaemia patients, were 39.27% and 32.16% respectively, higher than the general population (16.3%). Geographic analysis showed that provinces with higher proportions of hyperkalaemia were Jiangsu (9.22%), Hebei (8.31%), Tianjin (6.74%), Hunan (6.27%) and Liaoning (5.56%). In addition, the seasonal proportion varied as winter (4.18%), autumn (3.93%), spring (3.83%) and summer (3.57%). In patients with hyperkalaemia, the overall hyperkalaemia diagnosed rate within the episode was 2.53%. Diagnosed rates increased by the severity of hyperkalaemia, patients with S-K ≥7.0 mmol/L showed the highest diagnosed rate of 9.63%. The overall hyperkalaemia treated rate was 8.69%. The treated rate of patients with S-K 5.0 to 5.5mmol/L was much lower than that of patients with S-K 5.5 -6.0mmol/L (6.6% vs. 12.01%). The overall retesting rate within 7 days was 11.41%. Patients with S-K 5.0-5.5 mmol/L were retested less frequently (8.51%) than those with S-K ≥5.5 mmol/L (15.56-21.76%).
Conclusion
The proportions of hyperkalaemia in patients with chronic kidney disease, heart failure, hypertension and diabetes were higher than the proportion in overall outpatients. The severity of hyperkalaemia increased in patients with chronic kidney disease and heart failure. The diagnosed rate, treated rate and resting rate of hyperkalaemia in outpatients were low, showing a slight raise with increased severity.
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