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Dyskaliémie : fréquence, pronostic, prise en charge et iatrogénèse

Abstract : Context: Potassium disorders are frequent and associated with increased all-cause mortality, taking the form of a U-shaped curve. Nevertheless, there are little data on dyskalemia in the emergency department, especially in non-critical patients, even though it represents a significant part of the activity of emergency departments. Moreover, we have no data on the management of dyskalemia by general practitioners. Objectives: The objectives were to study the factors associated with dyskalemia in non-critical patients in the emergency department, and to learn about the practices of general practitioners and residents faced with the discovery of hyper or hypokalemia (known thresholds, management thresholds and attitude towards drugs with an action on kalemia). Methods: For the first article, we used data from a multi-center (11 emergency centers) cross-sectional observational study. For the second article, we conducted a telephone survey of 500 general practitioners throughout France. For the third article, we interviewed 357 general practice residents using self-administered questionnaires. Results: We described the factors associated with the presence of dyskalemia in emergency departments in patients presenting with non-critical medical condition. Dyskalemia is common and hypokalemia was found in almost 50% of patients. This proportion is higher than that described in populations with all emergency department visits, suggesting that hypokalemia is prevalent in non-critical patients. Hypokalemia in this population is associated with female gender and the use of thiazide diuretics. It is also associated with a poorer prognosis. Hyperkalemia was associated with angiotensin-aldosterone renin system blocker drugs and chronic renal failure. Our survey of 500 general practitioners in France shows that there is great heterogeneity in the management of dyskalemia by general practitioners and that some practices are not optimal, for example the non-biological control in case of hyperkalemia or the definitive discontinuation of proven cardiovascular-renal protection drugs. Our survey of residents revealed a great similarity of practices with those of practicing physicians. In fact, both in general practitioners and residents, the usual thresholds for dyskalemia are known and the differences reflect the different definitions found in the literature. The most salient result is the fact that hypokalemia seems to be more neglected than hyperkalemia. Conclusions: Our three studies converge on the basis that the risk of hypokalemia severity is probably not well known. All these data confirm the hypothesis that a sub-optimal management of dyskalemia, and mainly hypokalemia in primary care, may contribute to its preponderance in emergency rooms, for non-critical patients. Hypokalemia has a potential negative impact in terms of public health as it represents a silent and little-known killer that should be unmasked and exposed.
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Submitted on : Monday, March 29, 2021 - 3:59:11 PM
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  • HAL Id : tel-03184570, version 1

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Laure Abensur Vuillaume. Dyskaliémie : fréquence, pronostic, prise en charge et iatrogénèse. Physiologie [q-bio.TO]. Université de Lorraine, 2020. Français. ⟨NNT : 2020LORR0200⟩. ⟨tel-03184570⟩

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