Hypokalemia in Patients with COVID-19

Clin Exp Nephrol. 2021 Apr;25(4):401-409. doi: 10.1007/s10157-020-01996-4. Epub 2021 Jan 4.

Abstract

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.

Keywords: COVID; Coronavirus; Electrolytes; Hypokalemia; Magnesium; Potassium.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • COVID-19 / complications*
  • Diuretics / adverse effects
  • Female
  • Hospital Mortality
  • Humans
  • Hypokalemia / drug therapy
  • Hypokalemia / epidemiology
  • Hypokalemia / etiology*
  • Male
  • Middle Aged
  • Potassium / blood
  • Potassium / urine
  • Prevalence
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2*

Substances

  • Diuretics
  • Potassium