Serum Potassium and Outcomes in CKD
Open Access
- 1 May 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 5 (5), 762-769
- https://doi.org/10.2215/cjn.05850809
Abstract
Background and objectives: The relationship between serum potassium (SK) and mortality in chronic kidney disease (CKD) has not been systematically investigated. Design, setting, participants, & measurements: We examined the predictors and mortality association of SK in the Renal Research Institute CKD Study cohort, wherein 820 patients with CKD were prospectively followed at four US centers for an average of 2.6 years. Predictors of SK were investigated using linear and repeated measures regression models. Associations between SK and mortality, the outcomes of ESRD, and cardiovascular events in time-dependent Cox models were examined. Results: The mean age was 60.5 years, 80% were white, 90% had hypertension, 36% had diabetes, the average estimated GFR was 25.4 ml/min per 1.73 m2, and mean baseline SK was 4.6 mmol/L. Higher SK was associated with male gender, lower estimated GFR and serum bicarbonate, absence of diuretic and calcium channel blocker use, diabetes, and use of angiotensin-converting enzyme inhibitors and/or statins. A U-shaped relationship between SK and mortality was observed, with mortality risk significantly greater at SK ≤4.0 mmol/L compared with 4.0 to 5.5 mmol/L. Risk for ESRD was elevated at SK ≤4 mmol/L in SK categorical models. Only the composite of cardiovascular events or death as an outcome was associated with higher SK (≥5.5). Conclusions: Although clinical practice usually emphasizes greater attention to elevated SK in the setting of CKD, our results suggest that patients who have CKD and low or even low-normal SK are at higher risk for dying than those with mild to moderate hyperkalemia.Keywords
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