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, 41 (6), 456-63

Serum Potassium, End-Stage Renal Disease and Mortality in Chronic Kidney Disease


Serum Potassium, End-Stage Renal Disease and Mortality in Chronic Kidney Disease

Georges N Nakhoul et al. Am J Nephrol.


Background/aims: Hypokalemia and hyperkalemia are often noted in chronic kidney disease (CKD) patients, but their impact on mortality and end-stage renal disease (ESRD) is less well understood. We aimed at studying the associations between potassium disorders, and mortality and progression to ESRD in a CKD population.

Methods: Using our electronic health record-based CKD registry, 36,359 patients with eGFR <60 ml/min/1.73 m(2) and potassium levels measured from January 1, 2005 to September 15, 2009 were identified. We examined factors associated with hypokalemia (<3.5 mmol/l) and hyperkalemia (>5.0 mmol/l) using logistic regression models and associations between serum potassium levels (both as continuous and categorical variables) and all-cause mortality or ESRD using Cox-proportional hazards models.

Results: Serum potassium <3.5 mmol/l was noted among 3% and >5.0 mmol/l among 11% of the study population. In the multivariable logistic regression analysis, lower eGFR, diabetes and use of ACE inhibitors or Angiotensin-Receptor Blockers were associated with higher odds of having hyperkalemia. Heart failure and African American race were factors associated with higher odds of hypokalemia. After adjustment for covariates including kidney function, serum potassium <4.0 and >5.0 mmol/l were significantly associated with increased mortality risk, but there was no increased risk for progression to ESRD. Time-dependent repeated measures analysis confirmed these findings. When potassium was examined as a continuous variable, there was a U-shaped association between serum potassium levels and mortality.

Conclusion: In patients with stage 3-4 CKD, serum potassium levels <4.0 and >5.0 mmol/l are associated with higher mortality but not with ESRD.


Figure 1
Figure 1
Cumulative incidence curve for death and ESRD for various categories of serum potassium (Graph shows that the unadjusted risk for mortality and ESRD differ among patients with different serum potassium levels)
Figure 2
Figure 2
Relationship between serum potassium (as a continuous measure) and all-cause mortality (The graph shows a U-shaped relationship between continuous potassium and mortality. Splines were used to allow for non-linear relationship. Knots were placed at potassium values of 3.6, 4.1, 4.4, 4.7 and 5.3).

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