Effects of estimated glomerular filtration rate and diabetes mellitus on the effect of insulin for treating hyperkalemia during anesthesia.

Purpose: We analyzed the effectiveness of insulin for treating hyperkalemia (≥ 5 mEq/L) during anesthesia and the effects of the estimated glomerular filtration rate (eGFR) and diabetes mellitus (DM) on the insulin treatment.

Methods: Patients 18 years of age and older who received intravenous insulin lispro for hyperkalemia under general anesthesia between January 2010 and March 2020 were enrolled. We performed three propensity score matching analyses according to eGFR stages (eGFR ≥ 60 vs. 30 ≤ eGFR < 60 and eGFR ≥ 60 vs. eGFR < 30 mL/min/1.73 m) and DM status.

Results: The study included 475 patients. For patients with hyperkalemia during surgery, the odds ratios [ORs] of failure to decrease potassium (K) after insulin treatment were higher in patients with eGFR < 30 mL/min/1.73 m (adjusted OR 3.24; 95% confidence interval 1.38-7.64; P = 0.007) than in patients with eGFR ≥ 60 mL/min/1.73 m. There was no significant difference in the ORs of patients with 30 ≤ eGFR < 60 mL/min/1.73 m and DM.

Conclusion: The patients with a low eGFR had a higher incidence of K not decreasing after insulin treatment. Periodic assessment of K may be required during anesthesia.