Association between serum potassium levels and adverse outcomes in chronic kidney disease: the Fukushima CKD cohort study

Tanaka, Kenichi; Saito, Hiroko; Iwasaki, Tsuyoshi; Oda, Akira; Watanabe, Shuhei; Kanno, Makoto; Kimura, Hiroshi; Shimabukuro, Michio; Asahi, Koichi; Watanabe, Tsuyoshi; Kazama, Junichiro James

doi:10.1007/s10157-020-02010-7

Cited by 17 publications

(21 citation statements)

References 26 publications

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“…Recently, the treatment of hypokalemia has generally depended on the severity and presence of electrocardiograph abnormalities or symptoms, and thresholds for treatment initiation have not been defined. Our analyses showed that the lowest risk for mortality was at 4.0 mmol/L, and multiple studies suggest that the optimal range is 4.0 to 5.0 mmol/L [ 5 , 7 ] ; thus, it is not clearly defined whether the normal range with values of 3.5 to 3.9 mmol/L should be applied. More studies should focus on this area in the future.…”

Section: Discussionmentioning

confidence: 79%

“…[ 9 ] Therefore, low serum potassium may suggest a poor nutritional status of the patient and is associated with poor survival. [ 5 , 7 ]…”

Section: Discussionmentioning

confidence: 99%

“…In line with this finding, a previous study showed that there was no significant association between serum potassium levels and mortality after multivariate adjustment, including for nutritional status. [ 5 ] While this attenuation may provide evidence that albumin confounds the true relationship between potassium and mortality, it could also suggest that albumin is a mediator of the effect of potassium on mortality. Further analysis showed that albumin was a significant mediator in the link between potassium and AC and CV mortalities, verifying that the relationship between potassium and mortality was significantly mediated by nutritional status in this study.…”

Section: Discussionmentioning

confidence: 99%

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Mediation of serum albumin in the association of serum potassium with mortality in Chinese dialysis patients: a prospective cohort study

Huang

Liu

et al. 2023

Chinese Medical Journal

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Background:The clinical importance of hypokalemia is likely underrecognized in Chinese dialysis patients, and whether its clinical effect was mediated by serum albumin is not fully elucidated. This study aimed to explore the association between serum potassium and mortality in dialysis patients of a Chinese nationwide multicenter cohort, taking albumin as a consideration.Methods:This was a prospective nation-wide multicenter cohort study. Restricted cubic splines were used to test the linearity of serum potassium and relationships with all-cause (AC) and cardiovascular (CV) mortality and a subsequent two-line piecewise linear model was fitted to approach the nadir. A mediation analysis was performed to examine relations of albumin to potassium and mortalities.Results:A total of 10,027 patients were included, of whom 6605 were peritoneal dialysis and 3422 were hemodialysis patients. In the overall population, the mean age was 51.7 ± 14.8 years, 55.3%(5546/10,027) were male, and the median dialysis vintage was 13.60 (4.70, 39.70) months. Baseline serum potassium was 4.30 ± 0.88 mmol/L. After a median follow-up period of 26.87 (14.77, 41.50) months, a U-shape was found between potassium and mortality, and a marked increase in risk at lower potassium but a moderate elevation in risk at higher potassium were observed. The nadir for AC mortality risk was estimated from piecewise linear models to be a potassium concentration of 4.0 mmol/L. Interestingly, the significance of the association between potassium and mortality was attenuated when albumin was introduced into the extended adjusted model. A subsequent significant mediation by albumin for potassium and AC and CV mortalities were found (P < 0.001 for both), indicating that hypokalemia led to higher mortality mediated by low serum albumin, which was a surrogate of poor nutritional status and inflammation.Conclusions:Associations between potassium and mortalities were U-shaped in the overall population. The nadir for AC mortality risk was at a potassium of 4.0 mmol/L. Serum albumin mediated the association between potassium and AC and CV mortalities.

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Section: Discussionmentioning

confidence: 79%

“…[ 9 ] Therefore, low serum potassium may suggest a poor nutritional status of the patient and is associated with poor survival. [ 5 , 7 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mediation of serum albumin in the association of serum potassium with mortality in Chinese dialysis patients: a prospective cohort study

Huang

Liu

et al. 2023

Chinese Medical Journal

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“…The Fukushima Cohort Study is a prospective survey of patient characteristics and outcomes for subjects having one or more cardiovascular risk factors, such as CKD, hypertension, diabetes, and dyslipidemia, who were followed at the Fukushima Medical University Hospital and enrolled between June 2012 and July 2014 ( 16 ). The Fukushima CKD Cohort Study is a sub-cohort of the Fukushima Cohort Study of subjects with NDD-CKD ( 17 ).…”

Section: Methodsmentioning

confidence: 99%

Association between Serum Inorganic Phosphorus Levels and Adverse Outcomes in Chronic Kidney Disease: The Fukushima CKD Cohort Study

et al. 2022

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Objective Although an association between serum inorganic phosphorus levels and a poor prognosis has been noted in dialysis patients, these associations have been insufficiently reported in non-dialysis-dependent chronic kidney disease (NDD-CKD) patients. This study attempted to determine the association between serum inorganic phosphorus levels and adverse outcomes in Japanese NDD-CKD patients. Methods We investigated the relationships between serum inorganic phosphorus levels and adverse outcomes, such as kidney events, cardiovascular events, and all-cause death, in Japanese NDD-CKD patients using longitudinal data from the Fukushima CKD Cohort Study with a median follow-up period of 2.8 years. The study evaluated 822 patients with NDD-CKD enrolled between June 2012 and July 2014. A kidney event was defined as a combination of doubling of the baseline serum creatinine or end-stage renal disease. Cox regression was performed to analyze the relationships of the quartile of the serum inorganic phosphorus with kidney events, cardiovascular events, and all-cause death. Results The frequency of kidney events per 1,000 person-years exhibited a U-shaped distribution based on serum inorganic phosphorus levels, with these levels not significantly associated with an increased risk of cardiovascular events and all-cause death. A multivariable Cox regression analysis showed an increased risk of kidney events for the highest quartile of the serum inorganic phosphorus levels (≥3.7 mg/dL) versus the second quartile (2.9-3.2 mg/dL, hazard ratio, 3.30; 95% confidence interval, 1.50-7.28; p=0.003). There were no significant associations between the serum calcium levels and adverse outcomes. Conclusion Serum inorganic phosphorus levels were associated with an increased risk of CKD progression in Japanese NDD-CKD patients.

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“…In the cohorts of patients with no overt CKD at baseline, the risk of hyperkalaemia exponentially increased for lower GFR [ 4 ]. The prevalence of chronic hyperkalaemia estimated in cohorts of CKD patients ranged from 5.6% in patients with a mean eGFR of 62 mL/min/1.73 m 2 to over 50% in the more advanced CKD stages [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ].…”

Section: Hyperkalaemia In General Population and In Chronic Kidney Di...mentioning

confidence: 99%

Chronic Hyperkaliemia in Chronic Kidney Disease: An Old Concern with New Answers

Borrelli

Matarazzo

Lembo

et al. 2022

IJMS

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Increasing potassium intake ameliorates blood pressure (BP) and cardiovascular (CV) prognoses in the general population; therefore the World Health Organization recommends a high-potassium diet (90–120 mEq/day). Hyperkalaemia is a rare condition in healthy individuals due to the ability of the kidneys to effectively excrete dietary potassium load in urine, while an increase in serum K+ is prevalent in patients with chronic kidney disease (CKD). Hyperkalaemia prevalence increases in more advanced CKD stages, and is associated with a poor prognosis. This scenario generates controversy on the correct nutritional approach to hyperkalaemia in CKD patients, considering the unproven link between potassium intake and serum K+ levels. Another concern is that drug-induced hyperkalaemia leads to the down-titration or withdrawal of renin-angiotensin system inhibitors (RASI) and mineralocorticoids receptors antagonists (MRA) in patients with CKD, depriving these patients of central therapeutic interventions aimed at delaying CKD progression and decreasing CV mortality. The new K+-binder drugs (Patiromer and Sodium-Zirconium Cyclosilicate) have proven to be adequate and safe therapeutic options to control serum K+ in CKD patients, enabling RASI and MRA therapy, and possibly, a more liberal intake of fruit and vegetables.

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Association between serum potassium levels and adverse outcomes in chronic kidney disease: the Fukushima CKD cohort study

Cited by 17 publications

References 26 publications

Mediation of serum albumin in the association of serum potassium with mortality in Chinese dialysis patients: a prospective cohort study

Mediation of serum albumin in the association of serum potassium with mortality in Chinese dialysis patients: a prospective cohort study

Association between Serum Inorganic Phosphorus Levels and Adverse Outcomes in Chronic Kidney Disease: The Fukushima CKD Cohort Study

Chronic Hyperkaliemia in Chronic Kidney Disease: An Old Concern with New Answers

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