Hyperkalemia Doubles Odds of ICU Stay Among Patients With Renal Failure With Complications at Large Tennessee Hospitals
In Hyperkalemia

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By: James Pitt  May. 16, 2018

Hyperkalemia, an excess of blood potassium, is an electrolyte imbalance that is especially common in patients with heart failure or chronic kidney disease. Up to 6.35% of patients with HF or CKD have hyperkalemia. Dexur has previously reported on hyperkalemia and heart failure in Florida.

A 2009 retrospective study of 245,808 patients in Veterans Administration data found that hyperkalemia increased the odds of mortality in patients with chronic kidney disease. To examine morbidity short of death, Dexur analysts examined ICU stay data from 2013-2016. The study population was Medicare-eligible inpatients at Tennessee hospitals with over 5,000 CMS inpatient discharges per year.

For patients with renal failure with complications (DRG 682) or major complications (DRG 683), comorbid hyperkalemia approximately doubled the odds of ICU stay. The effect was particularly strong in Nashville hospitals and weaker in Memphis hospitals.

The effect was strongest at Jackson-Madison County General Hospital (Jackson, TN). At Jackson-Madison, DRG 682 patients were 2.84 times and DRG 683 patients were 3.64 times more likely to have an ICU stay if they had hyperkalemia than if they did not have hyperkalemia. Jackson-Madison may serve a particularly ill kidney failure population in general: 74% of DRG 682 and 80% of DRG 683 inpatients at this hospital had an ICU stay.

Hyperkalemia had the least impact on ICU stays in kidney failure patients in St. Francis Hospital (Memphis, TN), with an odds ratio of 1.38 for DRG 682 and 1.97 for DRG 683. Parkwest Medical Center (Knoxville, TN) also had less trouble with hyperkalemia, with odds ratios 1.71 for DRG 682 and 1.95 for DRG 683. Neither of these hospitals had unusual rates of hyperkalemia or of kidney failure ICU stays, so this may reflect their practices in hyperkalemia treatment.

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For DRG 682:

  1. Total DRG Discharges
  2. Total Hyperkalemia Discharges at DRG
  3. Percentage of discharges at DRG with ICU Stay (Without Hyperkalemia)
  4. Percentage of discharges at DRG with ICU Stay (With Hyperkalemia)
  5. Difference in ICU Stay % with & without Hyperkalemia
  6. State Difference in ICU Stay % with & without Hyperkalemia
  7. National Difference in ICU Stay % with & without Hyperkalemia
  8. Odds of ICU stay if hyperkalemia
  9. Odds of ICU stay if no hyperkalemia
  10. Odds ratio of ICU stay with hyperkalemia vs without hyperkalemia

    11. At Johnson City Medical Center (Johnson City, TN), St Francis Hospital (Memphis, TN), Tristar Centennial Medical Center (Nashville, TN), Jackson - Madison County General Hospital (Jackson, TN), Parkwest Medical Center (Knoxville, TN), Parkridge Medical Center (Chattanooga, TN), Saint Thomas Midtown Hospital (Nashville, TN), Skyline Medical Center (Nashville, TN), University Of Tennessee Medical Center (Knoxville, TN), Methodist University Hospital (Memphis, TN), CHI Memorial Hospital – Chattanooga (Chattanooga, TN(, Wellmont Bristol Regional Medical Center (Bristol, TN), Vanderbilt University Hospital (Nashville, TN), and Wellmont Holston Valley Medical Center (Kingsport, TN)

    For DRG 683:

  11. Total DRG Discharges
  12. Total Hyperkalemia Discharges at DRG
  13. Percentage of discharges at DRG with ICU Stay (Without Hyperkalemia)
  14. Percentage of discharges at DRG with ICU Stay (With Hyperkalemia)
  15. Difference in ICU Stay % with & without Hyperkalemia
  16. State Difference in ICU Stay % with & without Hyperkalemia
  17. National Difference in ICU Stay % with & without Hyperkalemia
  18. Odds of ICU stay if hyperkalemia
  19. Odds of ICU stay if no hyperkalemia
  20. Odds ratio of ICU stay with hyperkalemia vs without hyperkalemia

At Johnson City Medical Center (Johnson City, TN), St Francis Hospital (Memphis, TN), Tristar Centennial Medical Center (Nashville, TN), Jackson - Madison County General Hospital (Jackson, TN), Parkwest Medical Center (Knoxville, TN), Parkridge Medical Center (Chattanooga, TN), Saint Thomas Midtown Hospital (Nashville, TN), Methodist University Hospital (Memphis, TN), Wellmont Bristol Regional Medical Center (Bristol, TN), Vanderbilt University Hospital (Nashville, TN), and Wellmont Holston Valley Medical Center (Kingsport, TN)

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ABOUT THE AUTHOR

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James Pitt

James Pitt is a science writer with experience in medical devices and textbook publishing. His hobbies include reading, flintknapping, and squinting at RStudio. He received a bachelor's in Human Evolutionary Biology from Harvard.