OBJECTIVES : To estimate the impact of hyperkalemia (HK) on 1-year survival and all-cause healthcare resource utilization among patients with chronic kidney disease (CKD) in China.

METHODS : Data were obtained from Tianjin Urban Employee Basic Medical Insurance database. Adult new-onset CKD patients who experienced ≥1 hyperkalemic event (ICD-10 codes E87.5) were identified between January 1, 2012 and December 31, 2016. 1:1 propensity score matching was conducted between HK and non-HK cohorts based on baseline (12-month pre-index period) demographic and clinical characteristics. Survival and all-cause healthcare resource utilization were compared during a 12-month follow-up period using Kaplan-Meier (KM) curves (Log-rank test and Cox proportional hazard model) and KM sample average method, respectively.

RESULTS : Among 207,232 eligible CKD patients, 1,003 pairs of HK patients and matched controls were included (mean age 67.2 ± 14.3 years, 40.3% female). The 1-year all-cause mortality was much higher in the HK cohort than the non-HK cohort (36.4% vs. 8.3%, hazard ratio=5.39, P<0.001). The mean costs and number of healthcare services among HK patients in each follow-up month were significantly higher (P<0.05). An annual increase cost of ¥38,479 (¥59,210 vs. ¥20,732) was observed in HK cohort, largely due to the sharp increase in inpatient costs during the first month after HK events (¥22,204 vs. ¥1,032, P<0.001). Medication costs were the most important cost component for both cohorts (¥26,786 [45%] vs. ¥12,378[60%]). However, HK patients spent more on non-medication treatment (¥13,410 [23%] vs. ¥2,335[11%]) including nursing, monitoring, etc., primarily due to more emergency department visits, hospitalizations, and higher hospital tier visits. HK patients had more annual inpatient admissions (1.9 vs. 0.7) and length of stays (28.6 vs. 8.7), while number of outpatient visits (36.8 vs. 36.4) was similar.

CONCLUSIONS : In Chinese CKD patients, HK is significantly associated with increased mortality and healthcare resource utilization driven by the short period following the HK events.