Does dietary potassium intake associate with hyperkalemia in patients with chronic kidney disease?

Ramos, Christiane Ishikawa; González-Ortiz, Ailema; Espinosa-Cuevas, Ángeles; Avesani, Carla María; Carrero, Juan Jesús; Cuppari, Lílian

doi:10.1093/ndt/gfaa232

Cited by 85 publications

(93 citation statements)

References 34 publications

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“…The lack of association disclosed by the mixed effect analysis further confirms that K intake does not play a major role in the control of chronic HK in ND-CKD patients because of the predominant role of low GFR, acidosis and RAASI in these patients. This finding supports the results of previous studies in non-dialysis and dialysis CKD showing a dissociation between sK and potassium intake when estimated on the basis of food questionnaires [40]. It is important to note, however, that factors other than dietary intakes, such as gastrointestinal potassium secretion, or the effect of potassium binders and loop diuretics, that are common treatment options among CKD patients, could induce modifications in the amount of potassium absorbed in the bowel and/or urinary potassium elimination [41,42].…”

Section: Discussionsupporting

confidence: 92%

Current Management of Hyperkalemia in Non-Dialysis CKD: Longitudinal Study of Patients Receiving Stable Nephrology Care

et al. 2021

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Background: No study has explored the limitations of current long-term management of hyperkalemia (HK) in outpatient CKD clinics. Methods: We evaluated the association between current therapeutic options and control of serum K (sK) during 12-month follow up in ND-CKD patients stratified in four groups by HK (sK ≥ 5.0 mEq/L) at baseline and month 12: Absent (no-no), Resolving (yes-no), New Onset (no-yes), Persistent (yes-yes). Results: We studied 562 patients (age 66.2 ± 14.5 y; 61% males; eGFR 39.8 ± 21.8 mL/min/1.73 m2, RAASI 76.2%). HK was “absent” in 50.7%, “resolving” in 15.6%, “new onset” in 16.6%, and “persistent” in 17.1%. Twenty-four hour urinary measurements testified adherence to nutritional recommendations in the four groups at either visit. We detected increased prescription from baseline to month 12 of bicarbonate supplements (from 5.0 to 14.1%, p < 0.0001), K-binders (from 2.0 to 7.7%, p < 0.0001), and non-K sparing diuretics (from 34.3 to 41.5%, p < 0.001); these changes were consistent across groups. Similar results were obtained when using higher sK level (≥5.5 mEq/L) to stratify patients. Mixed-effects regression analysis showed that higher sK over time was associated with eGFR < 60, diabetes, lower serum bicarbonate, lower use of non-K sparing diuretics, bicarbonate supplementation, and K-binder use. Treatment-by-time interaction showed that sK decreased in HK patients given bicarbonate (p = 0.003) and K-binders (p = 0.005). Conclusions: This observational study discloses that one-third of ND-CKD patients under nephrology care remain with or develop HK during a 12-month period despite low K intake and increased use of sK-lowering drugs.

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Section: Discussionsupporting

confidence: 92%

Current Management of Hyperkalemia in Non-Dialysis CKD: Longitudinal Study of Patients Receiving Stable Nephrology Care

et al. 2021

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“…Further, higher dietary intake of K is associated with better blood pressure control and lower risk of ischemic stroke [39-41]. However, current guidelines recommend restriction of dietary intake of K due to the risk of hyperkalemia [42], despite the lack of association between dietary K intake and serum K levels or hyperkalemia [43] and the known health benefits of high dietary K intake [2]. However, lack of dietary K intake data did not allow us to assess the association of dietary intake of K (in concurrence with serum K) with ischemic stroke.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Association of Dyskalemias with Ischemic Stroke in Advanced Chronic Kidney Disease Patients Transitioning to Dialysis

et al. 2021

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Introduction: Hypo- and hyperkalemia are associated with a higher risk of ischemic stroke. However, this association has not been examined in an advanced chronic kidney disease (CKD) population. Methods: From among 102,477 US veterans transitioning to dialysis between 2007 and 2015, 21,357 patients with 2 pre-dialysis outpatient estimated glomerular filtration rates <30 mL/min/1.73 m2 90–365 days apart and at least 1 potassium (K) each in the baseline and follow-up period were identified. We separately examined the association of both baseline time-averaged K (chronic exposure) and time-updated K (acute exposure) treated as categorized (hypokalemia [K <3.5 mEq/L] and hyperkalemia [K >5.5 mEq/L] vs. referent [3.5–5.5 mEq/L]) and continuous exposure with time to the first ischemic stroke event prior to dialysis initiation using multivariable-adjusted Cox regression models. Results: A total of 2,638 (12.4%) ischemic stroke events (crude event rate 41.9 per 1,000 patient years; 95% confidence interval [CI] 40.4–43.6) over a median (Q1–Q3) follow-up time of 2.56 (1.59–3.89) years were observed. The baseline time-averaged K category of hypokalemia (adjusted hazard ratio [aHR], 95% CI: 1.35, 1.01–1.81) was marginally associated with a significantly higher risk of ischemic stroke. However, time-updated hyperkalemia was associated with a significantly lower risk of ischemic stroke (aHR, 95% CI: 0.82, 0.68–0.98). The exposure-outcome relationship remained consistent when using continuous K levels for both the exposures. Discussion/Conclusion: In patients with advanced CKD, hypokalemia (chronic exposure) was associated with a higher risk of ischemic stroke, whereas hyperkalemia (acute exposure) was associated with a lower risk of ischemic stroke. Further studies in this population are needed to explore the mechanisms underlying these associations.

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“…Excessive limitation of potassium intake may lead to hypokalemia [20] , malnutrition [21] , and increased risk of poor prognosis [22] . However, a study showed a controversial finding that dietary potassium was not associated with serum potassium levels [23] . Nonetheless, it has been demonstrated that patients with higher RAAQ scores are at a lower risk of all-cause mortality from CKD [24] .…”

Section: The Impacts Of Diuretics Raas Indicators and Low Raaq Scorementioning

confidence: 99%

Analysis of Influencing Factors and a Prediction Model of Abnormal Serum Potassium in Patients with Chronic Kidney Disease

Li¹

2022

Preprint

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Objective: The high incidence of abnormal serum potassium in patients with chronic kidney disease have resulted in frequent cardiovascular adverse events and even death. Through a retrospective analysis of the clinical data of 273 patients with CKD, we analyzed the correlation between the general data of patients and serum potassium levels, and the risk factors for abnormal serum potassium, and constructed risk prediction models for abnormal serum potassium. Methods: In this paper, 273 patients with CKD who were admitted to the Second Affiliated Hospital of Xuzhou Medical University were selected for this retrospective analysis. The subjects were divided into two groups based on the presence of abnormal serum potassium. Preliminary literature retrieval was conducted to extract the risk factors that might affect serum potassium. Independent sample t test was used to analyze the differences between two groups, Pearson or Spearman test was used to analyze the linear correlation of data, and Logistic regression equation was used to construct the multiple regression analysis. Results: The use of diuretics ( P =0.046), the use of renin-angiotensin and aldosterone (RAAS) inhibitors ( P =0.040) and low score of Renal Adherence Questionnaire (RAAQ) ( P < 0.001) were independent risk factors for abnormal serum potassium. There was a positive linear correlation between serum potassium and age, serum creatinine, blood urea nitrogen, anion gap and RAAQ score in patients with CKD; each influencing factor was independent. Subgroup analysis showed that the use of diuretics, low RAAQ score and peritoneal dialysis were more likely to lead to hypokalemia, while hypertension, diabetes, use of RAAS inhibitors, low RAAQ score and hemodialysis were more likely to result in hyperkalemia. Conclusion: Poor compliance is a risk factor for abnormal serum potassium. On this basis, the use of diuretics and peritoneal dialysis may increase the risk of hypokalemia, and the use of RAAS, hypertension, diabetes, and peritoneal dialysis may increase the risk of hyperkalemia.

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Does dietary potassium intake associate with hyperkalemia in patients with chronic kidney disease?

Cited by 85 publications

References 34 publications

Current Management of Hyperkalemia in Non-Dialysis CKD: Longitudinal Study of Patients Receiving Stable Nephrology Care

Current Management of Hyperkalemia in Non-Dialysis CKD: Longitudinal Study of Patients Receiving Stable Nephrology Care

Association of Dyskalemias with Ischemic Stroke in Advanced Chronic Kidney Disease Patients Transitioning to Dialysis

Analysis of Influencing Factors and a Prediction Model of Abnormal Serum Potassium in Patients with Chronic Kidney Disease

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