• Gaetano Alfano, Annachiara Ferrari, Francesco Fontana, Rossella Perrone, Giacomo Mori, Elisabetta Ascione, Riccardo Magistroni, Giulia Venturi, Simone Pederzoli, Gianluca Margiotta, Marilina Romeo, Francesca Piccinini, Giacomo Franceschi, Sara Volpi, Matteo Faltoni, Giacomo Ciusa, Erica Bacca, Marco Tutone, Alessandro Raimondi, Marianna Menozzi, Erica Franceschini, Gianluca Cuomo, Gabriella Orlando, Antonella Santoro, Margherita Di Gaetano, Cinzia Puzzolante, Federica Carli, Andrea Bedini, Jovana Milic, Marianna Meschiari, Cristina Mussini, Gianni Cappelli, Giovanni Guaraldi, and Modena Covid-19 Working Group (MoCo19).
• Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy. gaetano.alfano@unimore.it.
• Clin. Exp. Nephrol. 2021 Apr 1; 25 (4): 401-409.

BackgroundPatients 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.MethodsA 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.ResultsHypokalemia 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.ConclusionsHypokalemia 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.

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