Efficacy, Safety of Hyperkalemia Management With Intravenous Insulin

Hyperkalemia is a common complication for patients with reduced kidney function, particularly for those receiving hemodialysis. Hypoglycemia is also common among patients with reduced kidney function and is a common complication of insulin-based hyperkalemia treatment.

Maram A. Alzahrani and colleagues conducted a retrospective, observational cohort study to assess the efficacy and safety of hyperkalemia treatment in hemodialysis-dependent and hemodialysis-nondependent patients and to identify risk factors associated with hypoglycemia. Their findings were published in the Journal of Clinical Medicine.

The study included 172 patients with reduced kidney function and hyperkalemia treated with intravenous insulin. The researchers evaluated the effectiveness of insulin at lowering potassium levels and compared the degree of the reduction within certain time frames. They also investigated the incidence of hypoglycemia as a complication of insulin therapy between hemodialysis-dependent and nondependent patients. In addition, the study compared the risk of outcomes such as all-cause intensive care unit (ICU) admission and all-cause and hyperkalemia-related hospital readmission within one month between cohorts.

The greatest reduction in serum potassium levels occurred within the first six hours after insulin was administered, at 1.1 and 0.9 mmol/L for hemodialysis-dependent and nondependent patients, respectively. Hypoglycemia incidence was 18%, with no significant difference observed between the groups. The odds of all-cause admission to an ICU were greater for the nondependent group, while the hemodialysis-dependent patients were more likely to be readmitted within one month with hyperkalemia. Patients who were older, had heart failure, or received a second dose of insulin to treat hyperkalemia were more likely to experience hypoglycemia.

The authors determined that, “Multiple complex factors contribute to the risk of complications with hyperkalemia treatment. Implementing adjusted management based on patients’ characteristics and the intensive monitoring of blood glucose levels for patients at risk after the administration of insulin could help address the issue of hypoglycemia following hyperkalemia treatment. Also, the underlying cause of hyperkalemia needs to be addressed to prevent readmission, particularly in hemodialysis-dependent patients.”

Source: Journal of Clinical Medicine