Etiological Factors and Clinical Outcomes of Acute Hyperkalemia Among Hospitalized Patients at a Tertiary Care Hospital in Peshawar

Background: Acute hyperkalemia is a potentially life-threatening electrolyte imbalance frequently encountered among hospitalized patients, particularly those with renal dysfunction and multiple comorbidities. It is associated with serious cardiac complications and increased morbidity and mortality. Understanding the underlying etiological factors and clinical outcomes is essential for timely diagnosis, appropriate management, and improved patient care. Objective: To determine the frequency, etiological factors, management strategies, and clinical outcomes of acute hyperkalemia among hospitalized patients at a tertiary care hospital in Peshawar. Methodology: This descriptive cross-sectional study was conducted in the Department of Nephrology, Northwest General Hospital and Research Centre, Peshawar, Pakistan, from September 2020 to June 2024. A total of 142 hospitalized patients with serum potassium levels >5.0 mEq/L were included using non-probability consecutive sampling. Data on demographic characteristics, clinical presentation, comorbidities, medication history, laboratory parameters, treatment modalities, and clinical outcomes were collected using a structured proforma. Hyperkalemia was classified as mild, moderate, or severe. Results: The median age of patients was 60 years (IQR = 19), with females comprising 54.9% of the cohort. Hypertension (59.9%), diabetes mellitus (48.6%), and chronic kidney disease (45.8%) were the most common comorbidities. Acute kidney injury was present in 49.3% of patients. Medications frequently associated with hyperkalemia included angiotensin-converting enzyme inhibitors (43.7%), diuretics (27.5%), and nonsteroidal anti-inflammatory drugs (23.9%). Severe hyperkalemia (>6.5 mEq/L) was observed in 47.2% of patients. Intravenous calcium (81%) and insulin-dextrose infusion (67.6%) were the most commonly used treatments. Potassium normalization was achieved in 41.5% of patients. Significant associations with potassium normalization were observed for nebulized salbutamol (p = 0.043) and intravenous bicarbonate (p = 0.016). Overall, 95.8% of patients were discharged in stable condition, while the in-hospital mortality rate was 4.2%. Conclusion: Acute hyperkalemia among hospitalized patients was commonly associated with multiple comorbidities and the use of potassium-altering medications, particularly ACE inhibitors and NSAIDs. Despite standard management, potassium normalization was achieved in less than half of patients, highlighting the need for individualized treatment strategies, vigilant monitoring, and early intervention to improve clinical outcomes. Keywords: Acute Hyperkalemia, Acute Kidney Injury, Clinical Outcomes, Electrolyte Imbalance, Potassium-Altering Medications.