Older age and in-hospital development of hypokalemia from loop diuretics: Results from a multicenter survey

Background. Hypokalemia is a common finding among older patients taking diu retic medications. However, it is not known whether older age per se carrie s an increased risk of hypokalemia, particularly during a patient's treatme nt with loop diuretics. Methods. The association between age and incident hypokalemia was examined in 18,872 patients with normal baseline serum potassium enrolled during thr ee yearly multicenter surveys; 4,035 patients started receiving loop diuret ics during their hospital stay. Demographic variables, comorbid conditions, medications, and objective tests that were associated with incident hypoka lemia in separate age- and sex-adjusted logistic regression models were exa mined as potential confounders. Results. Among patients with normal baseline serum potassium. the factors o f age, presence of coronary disease or diabetes, comorbidity, the use of AC E inhibitors, loop diuretics, digitalis, corticosteroids, or insulin, and b aseline serum potassium were associated with incident hypokalemia in initia l models, Alter these variables were adjusted for, age (for each decade, od ds ratio = 1.30: 95% confidence interval = 1.17-1.46; p < .0001) was associ ated with incident hypokalemia. The use of parenteral (2.30: 1.53-3.46; p < .0001) but not oral (1.16; 0.79-1.69, p = .44) loop diuretics was associat ed with hypokalemia. Eventually, age was associated with hypokalemia when t he summary regression model was analyzed in patients taking loop diuretics (1.33; 1.03-1.71; p = .027), as well as in those taking intravenous loop di uretics only (1.84: 1.25-2.70; p =,002). Conclusions, Older age is independently associated with the in-hospital dev elopment of hypokalemia. particularly among patients taking loop diuretics. Monitoring of serum potassium levels is therefore advisable when older pat ients are treated with these agents.