RESUMEN
INTRODUCTION: Older patients are at increased risk for hyperkalemia (HK). This study describes the prevalence, recurrence, and clinical and economic burden of HK in Medicare patients admitted to a long-term care (LTC) setting. METHODS: Retrospective cohort study using 100% Medicare Fee-for-Service (FFS) claims identified patients aged ≥ 65 years with index admission between 2017 and 2019 to a LTC setting (skilled nursing, home health, inpatient rehabilitation, or long-term acute care). Beneficiaries were required to have 12 months continuous medical and pharmacy coverage prior to index LTC admission and ≥ 30 days after LTC discharge (follow-up). Patient characteristics, healthcare resource utilization, and costs were assessed. HK was defined as ICD-10 diagnosis code E87.5 in any claim position or Medicare Part D fill for oral potassium binder. RESULTS: Of 4,562,231 patients with a LTC stay, the prevalence of HK was 14.7% over the full study period (pre-index, index stay, and follow-up). Excluding those with HK only during the follow-up period resulted in 4,081,103 patients. Of these, 290,567 (7.1%) had HK and 3,790,536 (92.9%) did not have HK during or within 14 days prior to index LTC stay. The HK recurrence rate during index stay and follow-up was 48.3%. Unmatched HK versus non-HK patients were more often male (43.0% vs. 35.4%), Black (13.5% vs. 8.0%), dual eligible for Medicaid (34.2% vs. 25.0%), with higher mean Charlson Comorbidity Index scores (6.2 vs. 3.9) (all p < 0.0001). After propensity matching, HK patients were 2.2 times more likely to be hospitalized, with higher mortality (30.8% vs. 21.5%) and higher total healthcare costs during both index stay (US$26,520 vs. $18,021; p < 0.0011) and follow-up ($57,948 vs. $41,744 (p < 0.0011) versus matched non-HK patients. CONCLUSION: Prevalence and recurrence of HK was high among LTC patients, and HK was associated with significantly greater clinical and economic burden during and post-LTC.
Hyperkalemia is a serious medical condition commonly occurring in nursing home residents. It is characterized by abnormally high blood levels of potassium that if untreated can be life-threatening. High levels of potassium can be the result of kidney disease and inability to remove potassium from the bloodstream; eating foods high in potassium; and/or taking medications that interfere with the kidney's ability to remove potassium from the bloodstream. Older patients who have chronic kidney disease, heart failure, diabetes, and high blood pressure are at particularly high risk for hyperkalemia. Management is difficult as it requires reducing intake of foods high in potassium, adjusting medications that cause hyperkalemia, and potentially treating with oral potassium binders to reduce potassium blood levels. This study focused on the clinical outcomes, healthcare services use, and costs incurred by Medicare beneficiaries 65 years and older admitted to long-term care, where the occurrence of hyperkalemia is often high yet unrecognized. Patients with a diagnosis of hyperkalemia immediately before and during admission to long-term care or after discharge had an increased rate of death compared with patients without a hyperkalemia diagnosis. Hyperkalemia patients also had more hospitalizations and visits to the Emergency Department and outpatient facilities, resulting in higher total medical costs. Total costs for hyperkalemia patients were highest for those with chronic kidney disease, heart failure, and diabetes.
