Victoria Socha

DocwireNews

Jill Davis, MS, and colleagues conducted a study to compare rates of progression of chronic kidney disease (CKD) between patients with and without hyperkalemia. The researchers reported results of the study during a poster session at Kidney Week 2019 in a poster titled Hyperkalemia and Progression of CKD.Inclusion criteria included &ge;18 years of age with CKD stages 3-4 and one or more estimated glomerular filtration rate (eGFR) measurements at baseline (6 months prior to the index date) and during the study period (up to 5 years post index date). Eligible patients were identified using electronic medical records from the US Research Action for Health Network (2012-2018). CKD stage was identified using diagnostic codes or eGFR measurement.The study examined two separate outcomes: (1) progression to CKD stage 5 and (2) &ge;10 unit decline in eGFR. Following adjustment for baseline eGFR, demographic characteristics, relevant comorbidities, and treatment use, Kaplan-Meier analyses and multivariable Cox models were performed. Sensitivity analyses were preformed adjusting for albumin-creatinine ratio (ACR), stratifying by baseline CKD stage, and excluding patients with baseline acute kidney injury (AKI).Compared with patients without hyperkalemia (n=36,764; mean age 72.7 years), those with hyperkalemia (n=9220; mean age 72.3 years) had higher rates of CKD stage 4 (33.9% vs 9.7%), heart failure (31.7% vs 15.0%), and AKI (33.8% vs 11.5%), and a higher ACR value (393.9 mg/g vs 154.4 mg/g).During the 5-year study period, 16.7% of patients in the hyperkalemia group progressed to CKD stage 5, compared with 3.7% of those in the non-hyperkalemia group. In the hyperkalemia group, 31.7% of patients had a decline in eGFR of &ge;10 units, compared with 17.0% of patients in the non-hyperkalemia group (both comparisons log-rank P&lt;.001).In Cox models, patients with versus without hyperkalemia had a statistically significant higher risk of CKD progression to CKD stage 5 (adjusted hazard ratio [aHR], 2.20; 95% confidence interval [CI], 2.02-2.38; P&lt;.001) and eGFR decline (aHR, 2.40; 95% CI, 2,28-2.52; P&lt;.001). Following adjustment for ACR, stratification by baseline CKD stage, or exclusion of patients with AKI, results of Cox models were consistent with those prior to adjustment.The researchers said, &ldquo;Even after adjusting for relevant comorbidities and treatments, hyperkalemia was significantly associated with higher risk of progression to CKD stage 5 and eGFR decline among patients with CKD stage 3-4. Associations were robust in all sensitivity analyses.&rdquo;Source: Davis J, Done N, Chamberlain CX, et al. Hyperkalemia and progression of CKD. Abstract of a poster presented during the American Society of Nephrology Kidney Week 2019 (Abstract FR-PO654), November 9, 2019, Washington, DC.

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Progression of CKD in Patients with and without Hyperkalemia

Chronic Kidney Disease

Jill Davis, MS, and colleagues conducted a study to compare rates of progression of chronic kidney disease (CKD) between patients with and without hyperkalemia. The ...

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