Hypokalemia in Patients with COVID-19

• Published in: Clinical and experimental nephrology Vol. 25; no. 4; pp. 401 - 409
• Main Authors: Alfano, Gaetano, Ferrari, Annachiara, Fontana, Francesco, Perrone, Rossella, Mori, Giacomo, Ascione, Elisabetta, Magistroni, Riccardo, Venturi, Giulia, Pederzoli, Simone, Margiotta, Gianluca, Romeo, Marilina, Piccinini, Francesca, Franceschi, Giacomo, Volpi, Sara, Faltoni, Matteo, Ciusa, Giacomo, Bacca, Erica, Tutone, Marco, Raimondi, Alessandro, Menozzi, Marianna, Franceschini, Erica, Cuomo, Gianluca, Orlando, Gabriella, Santoro, Antonella, Di Gaetano, Margherita, Puzzolante, Cinzia, Carli, Federica, Bedini, Andrea, Milic, Jovana, Meschiari, Marianna, Mussini, Cristina, Cappelli, Gianni, Guaraldi, Giovanni
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.04.2021; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Coronaviruses; COVID-19; COVID-19 - complications; Creatinine; Diuretics; Diuretics - adverse effects; Electrolytes; Female; Hospital Mortality; Humans; Hypocalcemia; Hypokalemia; Hypokalemia - drug therapy; Hypokalemia - epidemiology; Hypokalemia - etiology; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Nephrology; Original; Original Article; Patients; Potassium; Potassium - blood; Potassium - urine; Prevalence; Retrospective Studies; Risk Factors; SARS-CoV-2; Sex ratio; Urology; COVID; Hypokalemia; Electrolytes; Coronavirus; Magnesium; Potassium
• ISSN: 1342-1751; 1437-7799; 1437-7799
• DOI: 10.1007/s10157-020-01996-4

Background Patients with COVID-19 experience multiple clinical conditions that may cause electrolyte imbalances. Hypokalemia is a concerning electrolyte disorder closely associated with severe complications. This study aimed to estimate prevalence, risk factors and outcome of hypokalemia in a cohort of patients with confirmed COVID-19. Methods A retrospective analysis was conducted on 290 non-ICU admitted patients with COVID-19 at the tertiary teaching hospital of Modena, Italy, from February 16 to April 14, 2020. Results Hypokalemia was detected in 119 out of 290 patients (41%) during hospitalization. Mean serum potassium was 3.1 ± 0.1 meq/L. The majority of patients (90.7%) patients experienced only a mild decrease in serum potassium level (3–3.4 mEq/L). Hypokalemia was associated with hypocalcemia, which was detected in 50% of subjects. Urine potassium-to-creatinine ratio, measured in a small number of patients ( n  = 45; 36.1%), revealed an increase of urinary potassium excretion in most cases (95.5%). Risk factors for hypokalemia were female sex (odds ratio (OR) 2.44; 95% CI 1.36–4.37; P 0.003) and diuretic therapy (OR 1.94, 95% CI 1.08–3.48; P 0.027). Hypokalemia, adjusted for sex, age and SOFA score, was not associated with ICU transfer (OR 0.52; 95% CI 0.228–1.212; P  = 0.131), in-hospital mortality (OR, 0.47; 95% CI 0.170–1.324; P = 0.154) and composite outcome of ICU transfer or in-hospital mortality (OR 0.48; 95% CI 0.222–1.047; P  = 0.065) in our cohort of patients. Conclusions Hypokalemia was a frequent disorder in subjects with COVID-19. Female sex and diuretic therapy were identified as risk factors for low serum potassium levels. Hypokalemia was unrelated to ICU transfer and death in this cohort of patients.