{"id":24481,"date":"2026-09-08T16:32:27","date_gmt":"2026-09-08T20:32:27","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=24481"},"modified":"2026-09-09T16:38:57","modified_gmt":"2026-09-09T20:38:57","slug":"emergency-department-referral-and-short-term-death-after-outpatient-hyperkalemia","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/emergency-department-referral-and-short-term-death-after-outpatient-hyperkalemia\/","title":{"rendered":"Emergency department referral and short-term death after outpatient hyperkalemia: a population-based study"},"content":{"rendered":"<p><strong>Background<\/strong> \u2014 Hyperkalemia can be deadly, yet clinical decision-making for outpatient management is unclear. We sought to determine whether an emergency department encounter within 24 hours of a severe outpatient hyperkalemia result was associated with lower rates of immediate and short-term all-cause death.<\/p>\n<p><strong>Methods<\/strong> \u2014 We conducted a retrospective population-based cohort study in Ontario, Canada, involving adults (age \u226518 yr) with an outpatient potassium result greater than 6.2 mmol\/L from Jan. 1, 2007, to Dec. 24, 2021. Patients who presented to the emergency department were propensity matched (1:1) to patients who did not. We estimated risk ratios and risk differences for all-cause death within 1, 3, and 7 days after the encounter. We performed subgroup analyses based on kidney function, sex, diabetes, renin\u2013angiotensin\u2013aldosterone inhibitor use, potassium level, and ordering physician specialty.<\/p>\n<p><strong>Results<\/strong> \u2014 A total of 57 607 individuals had an outpatient potassium result greater than 6.2 mmol\/L. Among these individuals, 7469 emergency department encounters occurred. After matching, 6557 patients had an emergency department encounter and 6557 did not. Within 7 days, a total of 209 deaths (1.6%) occurred. The risk of death was significantly lower among those with an emergency department encounter at 1 day (risk ratio [RR] 0.39, 95% confidence interval [CI] 0.24 to 0.65), 3 days (RR 0.47, 95% CI 0.32 to 0.67), and 7 days (RR 0.69, 95% CI 0.52 to 0.90). Subgroup analysis showed the greatest mortality reduction among patients with higher potassium levels (&gt;6.6 mmol\/L) and impaired kidney function (estimated glomerular filtration rate &lt;30 mL\/min\/1.73 m2).<\/p>\n<p><strong>Interpretation<\/strong> \u2014 Presentation to the emergency department within 24 hours of a severe outpatient hyperkalemia result is associated with lower rates of immediate and short-term death. These findings support urgent emergency department referrals and underscore the need for standardized reporting and management guidelines.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background \u2014 Hyperkalemia can be deadly, yet clinical decision-making for outpatient management is unclear. We sought to determine whether an emergency department encounter within 24 hours of a severe outpatient hyperkalemia result was associated with lower rates of immediate and short-term all-cause death. Methods \u2014 We conducted a retrospective population-based cohort study in Ontario, Canada, [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[24],"migration-helper-qa-sample-set":[],"class_list":["post-24481","journal_article","type-journal_article","status-publish","hentry","topic-acute-and-emergency-services"],"acf":{"citation":"Chiu M, Nash DM, Smith G, El Hassan MA, Moist L, Garg AX, Jain AK. <em>CMAJ<\/em>. 2026; 198(30): E1176-E1185.","source_url":"https:\/\/doi.org\/10.1503\/cmaj.252008","ices_scientist":[20188,1242,1280],"site":[6739],"research_program":[6743],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Emergency department referral and short-term death after outpatient hyperkalemia: a population-based study<\/title>\n<meta name=\"description\" content=\"Background \u2014 Hyperkalemia can be deadly, yet clinical decision-making for outpatient management is unclear. 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