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Open AccessArticle

Serum Potassium Levels at Hospital Discharge and One-Year Mortality among Hospitalized Patients

1
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
2
Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
3
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
4
Department of Internal Medicine, University of Arizona, Tuscon, AZ 85721, USA
5
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
6
Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA
*
Author to whom correspondence should be addressed.
Medicina 2020, 56(5), 236; https://doi.org/10.3390/medicina56050236
Received: 11 April 2020 / Revised: 29 April 2020 / Accepted: 12 May 2020 / Published: 14 May 2020
Background and Objectives: The optimal range of serum potassium at hospital discharge is unclear. The aim of this study was to assess the relationship between discharge serum potassium levels and one-year mortality in hospitalized patients. Materials and Methods: All adult hospital survivors between 2011 and 2013 at a tertiary referral hospital, who had available admission and discharge serum potassium data, were enrolled. End-stage kidney disease patients were excluded. Discharge serum potassium was defined as the last serum potassium level measured within 48 h prior to hospital discharge and categorized into ≤2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4, 4.5–4.9, 5.0–5.4 and ≥5.5 mEq/L. A Cox proportional hazards analysis was performed to assess the independent association between discharge serum potassium and one-year mortality after hospital discharge, using the discharge potassium range of 4.0–4.4 mEq/L as the reference group. Results: Of 57,874 eligible patients, with a mean discharge serum potassium of 4.1 ± 0.4 mEq/L, the estimated one-year mortality rate after discharge was 13.2%. A U-shaped association was observed between discharge serum potassium and one-year mortality, with the nadir mortality in the discharge serum potassium range of 4.0–4.4 mEq/L. After adjusting for clinical characteristics, including admission serum potassium, both discharge serum potassium ≤3.9 mEq/L and ≥4.5 mEq/L were significantly associated with increased one-year mortality, compared with the discharge serum potassium of 4.0–4.4 mEq/L. Stratified analysis based on admission serum potassium showed similar results, except that there was no increased risk of one-year mortality when discharge serum potassium was ≤3.9 mEq/L in patients with an admission serum potassium of ≥5.0 mEq/L. Conclusion: The association between discharge serum potassium and one-year mortality after hospital discharge had a U-shaped distribution and was independent of admission serum potassium. Favorable survival outcomes occurred when discharge serum potassium was strictly within the range of 4.0–4.4 mEq/L. View Full-Text
Keywords: hypokalemia; hyperkalemia; potassium; electrolytes; discharge; mortality hypokalemia; hyperkalemia; potassium; electrolytes; discharge; mortality
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Thongprayoon, C.; Cheungpasitporn, W.; Thirunavukkarasu, S.; Petnak, T.; Chewcharat, A.; Bathini, T.; Vallabhajosyula, S.; Mao, M.A.; Erickson, S.B. Serum Potassium Levels at Hospital Discharge and One-Year Mortality among Hospitalized Patients. Medicina 2020, 56, 236.

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