MO493PATTERNS OF HYPERKALEMIA AND ASSOCIATED ADVERSE HEALTH OUTCOMES IN PERSONS WITH CHRONIC KIDNEY DISEASE. (29th May 2021)

• Record Type: Journal Article
• Authors: Trevisan, Marco; Clase, Catherine M; Evans, Marie; Ludvigsson, Jonas; Sjolander, Arvid; Carrero, Juan Jesus
• Is Part Of: Nephrology dialysis transplantation. Volume 36(2021)Supplement 1
• Publication Date: 2021-05-29
• Subjects: Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfab087.0013
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: Background and Aims: Patients with CKD are often described as having chronic hyperkalemia, but earlier studies have relied on a single potassium measurement. Whether the hyperkalemia in CKD is chronic or transient, and whether temporal patterns have different outcome implications, is unknown. Method: Observational study from the Stockholm Creatinine Measurements (SCREAM) project of patients with confirmed CKD G3-5. We extracted all data on potassium measured during routine outpatient care and estimated its longitudinal trajectories. At each month, we created a rolling assessment of the proportion of time in which potassium was abnormal during the previous year, defining patterns of normokalemia (100% of time with potassium 3.5-5.0 mmol/L), transient (<50% of time with potassium >5.0 mmol/L) and chronic hyperkalemia (≥50% of time with potassium >5.0 mmol/L). We described the presence of chronic and transient hyperkalemia throughout the spectrum of CKD G3-5 and identified clinical predictors by logistic regression. Through time-dependent Cox models we examined whether previous hyperkalemia patterns offer prognostic gain beyond that of the current potassium value. Results: We included 36, 511 participants (56% women) with confirmed CKD G3-5, median age 81 years, and eGFR 46 ml/min/1.73 m 2 . During 3-year-median follow-up, patterns of transient and chronic hyperkalemia were observed in 15% and 4% of patients with CKD G3a, increasing to 50% and 17% of patients with CKD G5. Factors associated with chronic hyperkalemia were younger age, male sex, more severe CKD category, presence of diabetes or heart failure, use of renin-angiotensin system inhibitors, and use of potassium binders. Major cardiovascular events (MACE) occurred in 13, 104 (36%) patients and 13, 570 (37%) died. In time-dependent models, independent of identified confounders and of time-updated potassium values, compared with the normokalemic pattern, patients with transient (HR 1.37, 95% CI 1.29-1.46) or chronic (HR 1.17, 95% CI 1.04-1.32) hyperkalemia patterns were at higher risk of MACE. Transient hyperkalemia pattern (HR 1.43, 95% CI 1.35-1.52) and time-updated elevated potassium, but not a state of chronic hyperkalemia (HR 1.07, 95% CI 0.95-1.20), predicted the risk of death. Conclusion: Chronic hyperkalemia occurs in 4-17% of patients with CKD G3-5. We did not observe a clear dose-response for the association between hyperkalemia pattern (normal, transient, chronic) with either MACE or death. There was modest incremental information in the previous potassium pattern, beyond potassium measured at a single time point.