TY - JOUR
T1 - Real World Evidence for Treatment of Hyperkalemia in the Emergency Department (REVEAL–ED)
T2 - A Multicenter, Prospective, Observational Study
AU - REVEAL-ED Study Investigators
AU - Peacock, W. Frank
AU - Rafique, Zubaid
AU - Clark, Carol L.
AU - Singer, Adam J.
AU - Turner, Stewart
AU - Miller, Joseph
AU - Char, Douglas
AU - Lagina, Anthony
AU - Smith, Lane M.
AU - Blomkalns, Andra
AU - Caterino, Jeffrey M.
AU - Kosiborod, Mikhail
N1 - Funding Information:
This study was sponsored and funded by ZS Pharma, Inc., a member of the AstraZeneca group. Jessica Mendoza, PhD, an employee of ZS Pharma, Inc., a member of the AstraZeneca group, provided editorial assistance for the preparation of this manuscript. David Morris of Webb Writes provided statistical support for this study and received consulting fees for this work from ZS Pharma, Inc., a member of the AstraZeneca group. Preparation of the manuscript for submission was funded by ZS Pharma, Inc., a member of the AstraZeneca group.
Funding Information:
We thank the investigators and patients who participated in this study. Sheridan Henness, PhD, of inScience Communications, Springer Healthcare, prepared the manuscript for submission under the direction of the authors; editorial assistance provided by inScience Communications, Springer Healthcare, was funded by AstraZeneca.
Publisher Copyright:
© 2018 The Authors
PY - 2018/12
Y1 - 2018/12
N2 - Background: Contemporary emergency department (ED) standard-of-care treatment of hyperkalemia is poorly described. Objective: Our aim was to determine the treatment patterns of hyperkalemia management in the ED. Methods: This multicenter, prospective, observational study evaluated patients aged ≥ 18 years with hyperkalemia (potassium [K+] level ≥ 5.5 mmol/L) in the ED from October 25, 2015 to March 30, 2016. K+-lowering therapies and K+ were documented at 0.5, 1, 2, and 4 h after initial ED treatment. The primary end point was change in K+ over 4 h. Results: Overall, 203 patients were enrolled at 14 U.S.-based sites. The initial median K+ was 6.3 (interquartile range [IQR] 5.7–6.8) mmol/L and median time to treatment was 2.7 (IQR 1.9–3.5) h post-ED arrival. Insulin/glucose (n = 130; 64%) was frequently used to treat hyperkalemia; overall, 43 different treatment combinations were employed within the first 4 h. Within 4 h, the median K+ for patients treated with medications alone decreased from 6.3 (IQR, 5.8–6.8) mmol/L to 5.3 (4.8–5.7) mmol/L, while that for patients treated with dialysis decreased from 6.2 (IQR 6.0–6.6) mmol/L to 3.8 (IQR 3.6–4.2) mmol/L. Hypoglycemia occurred in 6% of patients overall and in 17% of patients with K+ > 7.0 mmol/L. Hyperkalemia-related electrocardiogram changes were observed in 23% of all patients; 45% of patients with K+ > 7.0 mmol/L had peaked T waves or widened QRS. Overall, 79% were hospitalized; 3 patients died. Conclusions: Hyperkalemia practice patterns vary considerably and, although treatment effectively lowered K+, only dialysis normalized median K+ within 4 h.
AB - Background: Contemporary emergency department (ED) standard-of-care treatment of hyperkalemia is poorly described. Objective: Our aim was to determine the treatment patterns of hyperkalemia management in the ED. Methods: This multicenter, prospective, observational study evaluated patients aged ≥ 18 years with hyperkalemia (potassium [K+] level ≥ 5.5 mmol/L) in the ED from October 25, 2015 to March 30, 2016. K+-lowering therapies and K+ were documented at 0.5, 1, 2, and 4 h after initial ED treatment. The primary end point was change in K+ over 4 h. Results: Overall, 203 patients were enrolled at 14 U.S.-based sites. The initial median K+ was 6.3 (interquartile range [IQR] 5.7–6.8) mmol/L and median time to treatment was 2.7 (IQR 1.9–3.5) h post-ED arrival. Insulin/glucose (n = 130; 64%) was frequently used to treat hyperkalemia; overall, 43 different treatment combinations were employed within the first 4 h. Within 4 h, the median K+ for patients treated with medications alone decreased from 6.3 (IQR, 5.8–6.8) mmol/L to 5.3 (4.8–5.7) mmol/L, while that for patients treated with dialysis decreased from 6.2 (IQR 6.0–6.6) mmol/L to 3.8 (IQR 3.6–4.2) mmol/L. Hypoglycemia occurred in 6% of patients overall and in 17% of patients with K+ > 7.0 mmol/L. Hyperkalemia-related electrocardiogram changes were observed in 23% of all patients; 45% of patients with K+ > 7.0 mmol/L had peaked T waves or widened QRS. Overall, 79% were hospitalized; 3 patients died. Conclusions: Hyperkalemia practice patterns vary considerably and, although treatment effectively lowered K+, only dialysis normalized median K+ within 4 h.
KW - emergency department
KW - hyperkalemia
KW - observational study
KW - potassium levels
KW - treatment patterns
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U2 - 10.1016/j.jemermed.2018.09.007
DO - 10.1016/j.jemermed.2018.09.007
M3 - Article
C2 - 30391144
AN - SCOPUS:85055741771
SN - 0736-4679
VL - 55
SP - 741
EP - 750
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 6
ER -