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Eur Heart J. 2018 May 1;39(17):1535-1542. doi: 10.1093/eurheartj/ehy100.

Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis.

Author information

1
University of Tennessee Health Science Center, Memphis, TN, USA.
2
Memphis Veterans Affairs Medical Center, Memphis, TN, USA.
3
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA.
4
Department of Infection Immunity and Inflammation, University of Leicester, Leicester, UK.
5
John Walls Renal Unit, University Hospitals of Leicester, Leicester, UK.
6
Department of Medical Epidemiology and Biosatistics (MEB), Karolinska Institutet, Stockholm, Sweden.
7
Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.
8
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
9
Showa University, Office for Promoting Medical Research, Tokyo, Japan.
10
Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
11
Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan.
12
Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan.
13
Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, The Netherlands.
14
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
15
Diabetes Centre Zwolle, Isala hospital, Zwolle, The Netherlands.
16
BC Provincial Renal Agency, Vancouver, BC, Canada.
17
University of British Columbia, Vancouver, BC, Canada.
18
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
19
Centre for Nephrology, University College London, London, UK.
20
Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science Technology, Trondheim, Norway.
21
Division of Nephrology, Department of Medicine, St Olav University Hospital, Trondheim, Norway.

Abstract

Aims:

Both hypo- and hyperkalaemia can have immediate deleterious physiological effects, and less is known about long-term risks. The objective was to determine the risks of all-cause mortality, cardiovascular mortality, and end-stage renal disease associated with potassium levels across the range of kidney function and evaluate for consistency across cohorts in a global consortium.

Methods and results:

We performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high cardiovascular risk, and 10 chronic kidney disease (CKD)] in the CKD Prognosis Consortium. We used Cox regression followed by random-effects meta-analysis to assess the relationship between baseline potassium and adverse outcomes, adjusted for demographic and clinical characteristics, overall and across strata of estimated glomerular filtration rate (eGFR) and albuminuria. We included 1 217 986 participants followed up for a mean of 6.9 years. The average age was 55 ± 16 years, average eGFR was 83 ± 23 mL/min/1.73 m2, and 17% had moderate- to-severe increased albuminuria levels. The mean baseline potassium was 4.2 ± 0.4 mmol/L. The risk of serum potassium of >5.5 mmol/L was related to lower eGFR and higher albuminuria. The risk relationship between potassium levels and adverse outcomes was U-shaped, with the lowest risk at serum potassium of 4-4.5 mmol/L. Compared with a reference of 4.2 mmol/L, the adjusted hazard ratio for all-cause mortality was 1.22 [95% confidence interval (CI) 1.15-1.29] at 5.5 mmol/L and 1.49 (95% CI 1.26-1.76) at 3.0 mmol/L. Risks were similar by eGFR, albuminuria, renin-angiotensin-aldosterone system inhibitor use, and across cohorts.

Conclusions:

Outpatient potassium levels both above and below the normal range are consistently associated with adverse outcomes, with similar risk relationships across eGFR and albuminuria.

PMID:
29554312
PMCID:
PMC5930249
DOI:
10.1093/eurheartj/ehy100
[Indexed for MEDLINE]
Free PMC Article

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