Horm Metab Res 2024; 56(04): 300-307
DOI: 10.1055/a-2204-3163
Original Article: Endocrine Care

Unawareness of Primary Aldosteronism as a Common Cause of Hypokalemia – Insights from the IPAHK+ Trial (Incidence of Primary Aldosteronism in Patients with Hypokalemia)

1   Department for Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
,
Evangelia Stasi
1   Department for Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
,
Antonio Boan Pion
1   Department for Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
,
Regula Steiner
2   Institute for Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland
,
Zoran Erlic
1   Department for Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
,
Stefan R. Bornstein
1   Department for Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
3   Department of Medicine, Carl Gustav Carus, University of Dresden, Dresden, Germany
,
Isabella Sudano
4   University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
,
Martin Reincke
5   Medizinische Klinik Innenstadt, Klinikum der Universität München, München, Germany
,
Felix Beuschlein
1   Department for Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
5   Medizinische Klinik Innenstadt, Klinikum der Universität München, München, Germany
› Author Affiliations

Fundings Swiss National Centre of Competence in Research Kidney Control of Homeostasis — http://dx.doi.org/10.13039/501100017557; 310030L_182700 Deutsche Forschungsgemeinschaft — http://dx.doi.org/10.13039/501100001659; CRC/Transregio 205/1 Kurt und Senta Herrmann Stiftung — http://dx.doi.org/10.13039/501100008481; Horizon 2020 Framework Programme — http://dx.doi.org/10.13039/100010661; 633983
Preview

Abstract

Hypokalemia plays an important role in the diagnosis and management of primary aldosteronism (PA). While the hypokalemic variant of the disease accounts for about one third of all cases, little is known about the incidence of PA in hypokalemic populations. The IPAHK+ study is an epidemiological, cross-sectional trial to provide evidence on the incidence of PA in hypokalemic patients from a university hospital outpatient population. Recruitment of outpatients with hypokalemia≤3 mmol/l is carried out on a continuous referral-basis through an automated data delivery system. Up to an interim data closure, 66 patients underwent the study protocol. The mean age of the participants was 52.9±1.5 years with an equal sex ratio of 1:1 women to men, a mean potassium value of 2.78±0.31 mmol/l [1.8;3.0] and a prevalence of arterial hypertension of 72.7%. PA was diagnosed in 46.6% of all participants, all of whom had a history of hypertension. Incidence of PA increased continuously with decreasing potassium levels with proportions of 26.7%, 50% and 57.1% in the subgroups of 3.0 mmol/l (n=15), 2.8–2.9 mmol/l (n=22) and≤2.7 mmol/l (n=21), respectively. Prior to testing, 59.1% of all patients presented at least with one plausible other cause of hypokalemia. The incidence of PA in the investigated outpatient population was more than 4 out of 10 and inversely correlated with baseline potassium levels. Moderate or severe hypokalemia, regardless of its cause, should therefore prompt evaluation for PA in hypertensive individuals. Normotensive hypokalemic PA was not observed in this cohort.



Publication History

Received: 29 August 2023

Accepted after revision: 04 November 2023

Accepted Manuscript online:
04 November 2023

Article published online:
11 December 2023

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