Hyperkalemia and Cardiovascular Risks in Patients With CKD

By Charlotte Robinson - Last Updated: February 12, 2025

Few large observational studies have examined the association of hyperkalemia with cardiovascular outcomes among patients with nondialysis‐dependent chronic kidney disease (CKD). To address this gap, Abiy Agiro, PhD, and colleagues conducted a real-world evidence study comparing the risks of cardiovascular events in hospital settings among patients with CKD with and without hyperkalemia.

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The researchers identified adults with CKD stages 3b-4 with and without hyperkalemia using Optum’s deidentified Market Clarity Data from January 2016 through August 2022. They then completed exact and propensity score matching of patients with and without hyperkalemia. The index date was the first CKD stage 3b-4 diagnosis with one or more hyperkalemia diagnoses and one or more serum potassium measurements greater than 5.0 mmol/L in the previous 12 months (baseline) for patients with hyperkalemia and a randomly chosen CKD stage 3b-4 diagnosis for the control group.

The primary endpoint was major adverse cardiovascular events plus (MACE+), which was a composite comprising all‐cause mortality, myocardial infarction, stroke, or heart failure in the hospital setting. Secondary endpoints included (1) a composite of new-onset atrial fibrillation and other atrial and ventricular arrythmias and (2) heart failure alone.

The study cohorts included 5,301 matched pairs in the MACE+ analysis and 5,564 in the arrhythmia analysis. The researchers compared cardiovascular events between the cohorts using cause-specific Cox proportional hazards regression.

The risk of MACE+ was 32% (95% CI, 23-40) greater in the hyperkalemia cohort than in the cohort without hyperkalemia. Within the full MACE+ sample, patients with hyperkalemia had a 69% (95% CI, 53-86) higher risk of hospitalized heart failure than those without hyperkalemia. Within the full hospitalized arrhythmia sample, the risk of arrhythmia increased by 59% (95% CI, 44-75) with hyperkalemia (all P values <.001).

In sum, the risk for cardiovascular events and arrhythmia in the hospital setting was significantly greater among patients with hyperkalemia than among those without hyperkalemia.

Source: Journal of the American Heart Association 

 

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