Epidemiology of hyperkalemia among US emergency department patients without end-stage renal disease from 2016 to 2024

Objective: Hyperkalemia is a potentially life-threatening condition among patients presenting to the emergency department (ED). However, most epidemiological studies have focused on those with end-stage renal disease (ESRD), and recent large-scale data on the incidence and management of hyperkalemia in non-ESRD ED patients remain limited. Methods: This was a retrospective cohort study of adults (≥18 years) without ESRD who presented to the ED with hyperkalemia between January 1, 2016, and December 31, 2024. Patients were identified using ICD-10 codes from the Epic Cosmos database. The primary outcome was the incidence of hyperkalemia among all ED visits. Secondary outcomes included admission rates, cardiac arrest, hemodialysis, and administration of medications used to treat hyperkalemia. Data were analyzed using summary statistics and odds ratios with 95% confidence intervals. Results: Among 246,235,769 ED visits, 803,186 (0.33%) had an ICD-10 code for hyperkalemia, and 539,033 (67.11%) of these patients were admitted to the hospital. Cardiac arrest occurred in 18,044 cases (2.25%). Sodium bicarbonate was administered in 38.75% of patients, calcium gluconate or chloride in 32.64%, sodium zirconium cyclosilicate in 24.68%, sodium polystyrene sulfonate in 23.12%, and patiromer in 3.04%. Only 2.99% received hemodialysis. Conclusion: Among adult ED patients without ESRD, hyperkalemia was uncommon but clinically important, with two-thirds requiring admission and approximately 2% experiencing cardiac arrest. Sodium bicarbonate and calcium were frequently administered, while hemodialysis was rare.