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Clin J Am Soc Nephrol. 2019 Mar 7;14(3):330-340. doi: 10.2215/CJN.07820618. Epub 2019 Feb 14.

Urinary Potassium Excretion and Progression of CKD.

Author information

1
Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea.
2
Department of Prevention and Management, School of Medicine, Inha University, Incheon, Korea.
3
Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Korea.
4
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and.
5
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
6
Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea; hansh@yuhs.ac.

Abstract

BACKGROUND AND OBJECTIVES:

Data on whether low or high urinary potassium excretion is associated with poor kidney outcome have been conflicting. The aim of this study was to clarify the association between urinary potassium excretion and CKD progression.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

We investigated the relationship between lower urinary potassium excretion and CKD progression and compared three urinary potassium indices among 1821 patients from the Korean Cohort Study for Outcome in Patients with CKD. Urinary potassium excretion was determined using spot urinary potassium-to-creatinine ratio, spot urinary potassium concentration, and 24-hour urinary potassium excretion. Patients were categorized into four groups according to quartiles of each urinary potassium excretion metric. The study end point was a composite of a ≥50% decrease in eGFR from baseline values and ESKD.

RESULTS:

During 5326 person-years of follow-up, the primary outcome occurred in 392 (22%) patients. In a multivariable cause-specific hazard model, lower urinary potassium-to-creatinine ratio was associated with higher risk of CKD progression (adjusted hazard ratio, 1.47; 95% confidence interval, 1.01 to 2.12) comparing the lowest quartile with the highest quartile. Sensitivity analyses with other potassium metrics also showed consistent results in 855 patients who completed 24-hour urinary collections: adjusted hazard ratios comparing the lowest quartile with the highest quartile were 3.05 (95% confidence interval, 1.54 to 6.04) for 24-hour urinary potassium excretion, 1.95 (95% confidence interval, 1.05 to 3.62) for spot urinary potassium-to-creatinine ratio, and 3.79 (95% confidence interval, 1.51 to 9.51) for spot urinary potassium concentration.

CONCLUSIONS:

Low urinary potassium excretion is associated with progression of CKD.

KEYWORDS:

Confidence Intervals; Disease Progression; Follow-Up Studies; Kidney Failure, Chronic; Potassium; Proportional Hazards Models; Renal Insufficiency, Chronic; Urinary potassium excretion; chronic kidney disease; creatinine; glomerular filtration rate; kidney

Comment in

PMID:
30765533
PMCID:
PMC6419276
[Available on 2020-03-07]
DOI:
10.2215/CJN.07820618
[Indexed for MEDLINE]
Free PMC Article

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