623 - Hyperkalemia in Pediatric Nephrectomy- A Common Complication
Sunday, April 27, 2025
8:30am – 10:45am HST
Publication Number: 623.5243
Abigail M. Schnaith, Emory University School of Medicine/Children's Healthcare of Atlanta, Atlanta, GA, United States; Chia-shi Wang, Emory University School of Medicine, Atlanta, GA, United States; Larry A. Greenbaum, Emory University School of Medicine, Decatur, GA, United States
Pediatric Nephrology Fellow Emory University School of Medicine/Children's Healthcare of Atlanta Atlanta, Georgia, United States
Background: Indications for bilateral nephrectomies include proteinuria, recurrent UTIs, resistant hypertension and malignancy risk. Hyperkalemia due to potassium (K) release from injured tissue and loss of kidney function is a possible complication that may be life threatening and is not well studied in pediatric nephrectomies. Objective: Describe the frequency and risk factors for hyperkalemia in pediatric patients who underwent bilateral nephrectomies or unilateral nephrectomy of a single kidney. Design/Methods: This was a single center retrospective chart review of patients < 21y who underwent nephrectomies from 1/1/2014-5/31/2024. Indications for nephrectomy were collected from physician notes. K value obtained within 48 hours and closest to nephrectomies were considered the pre-operative (-op) K value. Peak K values intra-op, post-op day 0 and post-op day 1 were collected. Hyperkalemia associated with the nephrectomies was defined as intra-op or post-op K>5.1 mEq/L (mild: >5.1-5.9; severe >5.9) in children >1y and K> 5.5 (mild: >5.5-6.1; severe >6.1) in children < 1y. Treatment for hyperkalemia was defined as receiving medications or hemodialysis for hyperkalemia. We examined the association between sex, dialysis mode (HD, PD, none), type of nephrectomy (laparoscopic, open), receiving intra-op blood, receiving intra-op LR, and pre-op K value with the development of hyperkalemia associated with nephrectomies in an unadjusted manner using Fisher’s exact tests. Results: 46 patients underwent nephrectomies. The most common indications were hypertension (17, 37%) and proteinuria (18, 39%). Overall, 23 (50%) patients developed hyperkalemia, 18 (39%) had severe hyperkalemia and 21 (45%) received treatment for hyperkalemia (hemodialysis=0; medications=16; both=5). Among the 12 patients with unexpected post-op ICU admissions 7 (58%) had hyperkalemia, 5 (41%) required hyperkalemia treatment, 3 (25%) required ICU admission solely for severe hyperkalemia. Sex, dialysis mode, type of nephrectomy, receiving intra-op blood, and receiving intra-op LR were not associated with the development of hyperkalemia. Pre-op K value was associated with development of hyperkalemia. Pre-op K ≥4 was associated with risk of developing hyperkalemia (odds ratio 57.0; p< 0.01; 95% CI [8.5, 381.8]).
Conclusion(s): Hyperkalemia is a common complication in pediatric nephrectomy. Pre-op K ≥4 is associated with a higher risk of developing intra-op or post-op hyperkalemia. Monitoring intra-op and post-op K is indicated in pediatric nephrectomy and targeting a pre-op K < 4 may decrease the risk of hyperkalemia.
