Hyperkalemia and Progression of CKD

According to researchers in China, there are few data available on the adverse effect of hyperkalemia on progression of chronic kidney disease (CKD). Jinwei Wang and colleagues conducted a study to examine the association between hyperkalemia and CKD progression.

Results were reported during a poster session at the American Society of Nephrology Kidney Week 2023. The poster was titled Instantaneous and Persistent Elevation of Serum Potassium and Progression of CKD.

Patients with CKD stages G1-4 being treated in the outpatient clinic at Peking University First Hospital were recruited between 2010 and 2020. Eligible patients had two or more measurements of serum potassium during the first year after recruitment. Instantaneous potassium was defined as one time occurrence of serum potassium ≥5.0 mmol/L or lasting for less than 3 months. Persistent hyperkalemia was defined as repeated occurrence lasting for three or more months.

Patients were followed from the baseline period until initiation of renal replacement therapy (RRT), death, loss to follow-up, or December 31, 2020. The association between the study exposure and outcome was estimated using Cox proportional hazards regression model; the slope of estimated glomerular filtration rate (eGFR) with interactions between time and hyperkalemia status was estimated using linear mixed effects model.

The analysis included data on 527 patients. Mean age of the cohort was 56 years and 54.7% were male. CKD stage 1, 2, 3, and 4 was present in 3.6%, 12.0%, 55.4%, and 29.0% of the cohort, respectively. A total of 331 patients had no hyperkalemia; 85 experienced instantaneous hyperkalemia, and 111 had persistent hyperkalemia.

Mean follow-up was 4.45 years. During the follow-up period, there were 61 RRT events. There was an association between hyperkalemia and higher risk of RRT. Following multivariable adjustment, there were associations between both instantaneous hyperkalemia and persistent hyperkalemia with increased risk of RRT (hazard ratios, 2.43; 95% CI, 1.14-5.18 and 2.86; 95% cI, 1.48-5.54). There were also associations between both instantaneous hyperkalemia and persistent hyperkalemia and higher rate of eGFR decline.

In summary, the authors said, “Hyperkalemia, especially persistent status, was associated with higher risk of CKD progression among patients with CKD.”

Source: Wang J, Wang F, Zhao M-H. Instantaneous and persistent elevation of serum potassium and progression of CKD. TH-PO1031. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2023; November 2, 2023; Philadelphia, Pennsylvania.