Hyperkalemia in Patients with Type 2 Diabetes Mellitus: Risk Factors and Clinical Outcomes

Hyperkalemia is one of life-threatening electrolyte abnormalities. Diabetes mellitus (DM) is among the diseases in which patients can commonly develop hyperkalemia due to various factors. This study aimed to determine the occurrence of hyperkalemia and potential risk factors that contribute to development of hyperkalemia among type 2 diabetes mellitus (T2DM) patients. This is a single centered retrospective study in all deceased diabetic patients who were previously admitted to Sultan Ismail Petra Hospital, Kelantan state of Malaysia from January 2017 to December 2017 with or without hyperkalemia. A total of 132 patients were studied after screening for eligibility from medical records. Hyperkalemia was defined as potassium level ≥5.5 mEq/L. Univariate and multiple logistic regression analysis were used to identify potential risk factors associated with hyperkalemia. The occurrence of hyperkalemia among T2DM patients was 54.5%. In multivariable analysis, stage 4 CKD (eGFR: 15-29 ml/min/1.73m2) (AOR=0.154, 95%CI=0.003,0.763), use of ARB (AOR=26.269, 95%CI=1.25,548.50) and length of stay (AOR=1.007, 95%CI=1.001,1.013) were the significant risk factors for hyperkalemia. No significant difference between diabetes patients with hyperkalemia (DMHK) group with diabetes patients without hyperkalemia (DMWOHK) group in terms of clinical outcomes. Among diabetic patients with hyperkalemia, the mean time from development of hyperkalemia until death was 99.92±119.07 hours. In conclusion, this study shows that hyperkalemia is common among T2DM patient in our study setting. Although a number of factors may contribute to the high occurrence of hyperkalemia, the use of ARB, advanced CKD at stage 4 and length of stay are major determinants of hyperkalemia occurrence. Aggressive management of hyperkalemia may be beneficial as to prevent significant clinical outcomes requiring intensive care management and cardiac problem lead to death.