OBJECTIVES: To develop and validate a predictive model to identify patients at higher risk of developing hyperkalemia (HK) over a 12-month period.

METHODS: We utilized an administrative claims database from a US healthcare payer with 5M covered lives to select the model population. Inclusion criteria: 24 months of enrollment, ≥18 years of age, at least one estimated glomerular filtration rate (eGFR) or one chronic kidney disease (CKD) ICD-9/10-CM (i.e.: 585.x, N18.x) diagnosis code. Patients with HK or dialysis in the baseline period were excluded to predict incident HK (new cases only). The study covered 24 months with a 12-month (2016) baseline (CKD identification) period and 12-month (2017) prediction period. Models were developed using multivariate logistic regression. Patient variables included: demographics, CKD stages, comorbidities, labs, drugs known to cause HK, and healthcare resource utilization (HCRU). Predictive model performance measures included: area under receiver operating characteristic (ROC) curve (AUC), calibration, gain and lift charts; data partitions included: training, validation, and test.

RESULTS: Of 435,512 patients with CKD, 6,235 (1.43%) had incident HK in the prediction period. Patients with HK had higher comorbidity burden, use of renin-angiotensin-aldosterone system inhibitors and HCRU than those without HK. The model included 24 significant predictors. Increasing CKD stage and incremental increases in normal serum potassium levels were the strongest predictors (adjusted odds ratio [aOR] for stage 5 vs 1 = 11.62, 95% CI: 7.90–17.07; aOR for potassium per 0.1 mEq/L higher = 8.59, 95% CI: 7.85–9.40). The ROC curve and calibration analyses showed good predictive accuracy (AUC=0.836) and calibration

CONCLUSIONS: Using a single large administrative claims database, patients at high risk of HK could be identified up to 1 year in advance. Although external validation is needed, the findings support the use of this predictive model to better target at-risk patients for intervention and management of developing HK.