Association of Hypo- and Hyperkalemia with Disease Progression and Mortality in Males with Chronic Kidney Disease: The Role of Race

Abstract

Background/Aims: Abnormal serum potassium is associated with higher mortality in dialysis patients, but its impact on outcomes in predialysis chronic kidney disease (CKD) is less clear. Furthermore, blacks with normal kidney function have lower urinary potassium excretion, but it is unclear if such differences have a bearing on race-associated outcomes in CKD. Methods: We studied predialysis mortality and slopes of estimated glomerular filtration rate, eGFR) associated with serum potassium in 1,227 males with CKD. Mortality was examined in time-dependent Cox models, and slopes of eGFR in linear mixed effects models with adjustments for case mix and laboratory values. Results: Both hypo- and hyperkalemia were associated with mortality overall and in 933 white patients, but in 294 blacks hypokalemia was a stronger death predictor. Hypokalemia was associated with loss of kidney function independent of race: a 1 mEq/l lower potassium was associated with an adjusted difference in slopes of eGFR of -0.13 ml/min/1.73 m²/year (95% CI: -0.20 to -0.07), p < 0.001. Conclusion: Hypo- and hyperkalemia are associated with higher mortality in CKD patients. Blacks appear to better tolerate higher potassium than whites. Hypokalemia is associated with faster CKD progression independent of race. Hyperkalemia management may warrant race-specific consideration, and hypokalemia correction may slow CKD progression. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel

Cardiac status in patients of chronic kidney disease: an assessment by non-invasive tools

“…This was comparable with the study by Foley et al 17 having mean Hemoglobin levels of 8.4 ± 1.7 gm/dl in CKD patients and 5.45 ± 2.26 gm/ dl in a study by London GM 25 . In present study, mean S. Potassium levels in CKD patients 5.54 ± 0.54 mEq/ L. This was comparable to S. Potassium levels of ≥ 5 mEq/ L in studies conducted by Singh NP et al 25 and Hayes et al 20 . If LVHis detected on ECG it usually means that an advanced degree of cardiac involvement has already occurred.…”

Prevalence of Hyperkalemia in Diabetic and Non-Diabetic Patients with Chronic Kidney Disease: A Nested Case-Control Study

“…In a prospective cohort study of 500 patients with various cardiovascular diseases but no CKD, previous smoking history posed a protective role in hyperkalemia development [24] . However, in a cross-sectional study including 1,227 CKD patients smoking did not correlate significantly with serum potassium levels [25] . Time of blood sample acquisition with regards to smoking and subsequent adrenergic stimulation may have greatly affected these observations; in our study, blood sampling was performed with smoking abstinence of at least an hour, and thus, reduced adrenergic stimulation may have affected the results.…”

Inflammation: A Key Contributor to the Genesis and Progression of Chronic Kidney Disease

“…Importantly, serum K + of <4.0 mEq/L was associated with more rapid annual decline of kidney function, elevated C-reactive protein, elevated urine protein to creatinine ratio, reduced serum albumin, and elevated rate of malnutrition, consistent with an underlying mechanism of inflammation. Similarly, Hayes et al [40] evaluated a cohort of pre-dialysis CKD male patients ( n = 1,227) and found that serum K + of <3.6 mEq/L was associated with faster CKD progression compared to serum K + of 3.6-5.5 mEq/L. Several other studies demonstrated a significant association of serum K + <4.0 mEq/L and mortality, but the index of inflammation and follow up on CKD progression were not evaluated in sufficient detail [41][42][43] .…”