Factors Associated With Hyperkalemia by CKD Stage

The prevalence of hyperkalemia among individuals with chronic kidney disease (CKD) is 14% to 20%. Hyperkalemia is associated with various factors, including use of some antihypertensives, age, sex, diabetes mellitus, and cancer. L. Monserrat Perez-Navarro, MD, and colleagues  at Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico, conducted a transversal study to determine the prevalence and factors associated with hyperkalemia in patients with CKD by CKD stage.

Results of the study were reported during a poster session at the American Society of Nephrology Kidney Week 2023. The poster was titled Prevalence and Factors Associated With Hyperkalemia  in Outpatients With CKD.

The study cohort included patients with CKD who were treated at the nephrology service of the Hospital General de Mexico from February 2019 to August 2022. Regression logistics were used to estimate the prevalence and factors associated with hyperkalemia by CKD stage. Hyperkalemia was defined as serum potassium level >5.

A total of 1368 patients were included. Average age was 55.2 years, 51% were female, mean time since CKD diagnosis was 1 year, 74% were overweight or obese (mean body mass index, 27.1 kg/m²) and 16% (n=223) were receiving renal replacement therapy (93% of those were receiving hemodialysis). The most prevalent comorbidities were anemia (55%), hyperuricemia (52%), hypertriglyceridemia (50%), diabetes mellitus (46%), and hypertension (26%). The overall prevalence of hyperkalemia was 25%.

Factors associated with hyperkalemia by CKD stage were: stage 3a, diabetes mellitus (odds ratio [OR], 7.5; 95% CI, 1.6-34.7), use of angiotensin-converting enzyme inhibitors (OR, 3.7; 95% CI, 1.2-11.2), and hypertension (OR, 3.5; 95% CI, 1.1-10.9); stage 3b, diabetes mellitus (OR, 2.06; 95% CI, 1.1-3.8), us of nonsteroidal anti-inflammatory drugs (OR, 2.5; 95% CI, 1.04-6.2), and glucose >100 ml/dL (OR, 2.01; 95% CI, 1.04-3.8); stage 4, use of renin-angiotensin-aldosterone system inhibitors (OR, 3.9; 95% CI, 1.3-11.3); and stage 5, male sex (OR, 1.6; 95% CI, 1.13-2.45) and being on hemodialysis (OR, 1.8; 95% CI, 1.2-2.7).

In conclusion, the authors said, “Hyperkalemia presented a high prevalence in our population, which increases the risk of death, cardiovascular disease, and hospitalization. An intentional search is necessary from the early stages of CKD, as well as the different associated factors according to the CKD stage.”

Source: Perez-Navarro LM, Valdez-Ortiz R, Reyna-Blanco J. Prevalence and factors associated with hyperkalemia in outpatients with CKD. TH-PO1086. Abstract of a poster presented at the American Society of Nephrology Kidney Week; November 2, 2023; Philadelphia, Pennsylvania.