Prevalence of Hyperkalemia in Diabetic and Non-Diabetic Patients with Chronic Kidney Disease: A Nested Case-Control Study

Abstract

Background: Hyperkalemia is a potentially life-threatening disorder, usually complicating chronic kidney disease (CKD). Factors superimposed to reduced renal function are further elevating hyperkalemia risk, but their contribution is not fully elucidated. This study aimed to compare the prevalence of hyperkalemia in diabetic and non-diabetic patients with CKD. Methods: This is a nested case-control study of 180 type-2 diabetic and 180 non-diabetic patients with CKD followed in a Nephrology outpatient clinic, matched for gender, age and estimated glomerular filtration rate. Type-1 diabetes or end-stage renal disease patients were excluded. Prevalence of hyperkalemia was defined as potassium >5 mEq/l or use of sodium polystyrene sulfonate, and further by potassium >5, ≥5.2 and ≥5.5 mEq/l. It was calculated in both groups in whole and CKD stages separately. Univariate and multivariate logistic regression analysis were conducted to identify factors associated with hyperkalemia. Results: The prevalence of hyperkalemia was higher in diabetic CKD patients (27.2 vs. 20%, p = 0.107) and remained around 30% higher with all secondary definitions used, but never reached statistical significance. In Stage 2, no difference was noted (8.7 vs. 17.4%, p = 0.665); in Stage 3, it was significantly higher in diabetics (28.6 vs. 17.5%, p = 0.036); and in Stage 4, it was equally high in both groups (35.5 vs. 32.3%, p = 0.788). In multivariate analysis, Stage 4 CKD (OR 4.535, 95% CI 1.561-13.173), use of angiotensin-converting enzyme inhibitors (ACEIs; OR 2.228, 95% CI 1.254-3.958) and smoking (OR 2.254, 95% CI 1.218-4.171) were independently associated with hyperkalemia. Conclusions: Diabetes mellitus was found to elevate the prevalence of hyperkalemia only in CKD Stage 3 patients (moderately impaired renal function). Advanced CKD at Stage 4 and ACEIs are major determinants of hyperkalemia occurrence.

How Dangerous Is Hyperkalemia?

“…Other data indicate that RAAS inhibitor use is linked with more profound hyperkalemia and death in the elderly 65 and in patients with diabetic versus nondiabetic CKD. 66 In the randomized controlled Hypertension in Hemodialysis Patients Treated with Atenolol or Lisinopril trial, 67 lisinopril predisposed patients on dialysis to more hyperkalemia and higher cardiovascular morbidity than atenolol; although, the lack of a control group is a limitation to further generalizations that can be made from this study.…”

Chronic Hyperkalemia in Cardiorenal Patients: Risk Factors, Diagnosis, and New Treatment Options

“…Large proportions of many observational studies have evaluated the prevalence of chronic HK in CKD patients on the basis of a single sampling [32-34], whereas recent randomized controlled trials performed serum potassium laboratory tests at least twice in order to stratify patients to enroll for HK treatment [35-37]. …”

The novel non‐steroidal MR antagonist finerenone improves metabolic parameters in high‐fat diet‐fed mice and activates brown adipose tissue via AMPK‐ATGL pathway

“…In clinical practice, steroidal MRAs are underused, due to strong concerns about the risk of hyperkalemia, 30 particularly in HF patients with comorbidities such as T2DM or CKD. 59 Notably, FIN treatment was well tolerated in HF patients with CKD 60 and/or T2DM, 33 and led to a reduced incidence of hyperkalemia, compared to spironolactone treatment 60 and a nominally improved outcome of a composite clinical endpoint of death from any cause, cardiovascular hospitalizations, or emergency presentation for worsening heart failure compared to eplerenone. 33 Interestingly, CKD development is favored by obesity and T2DM 61,62 and the addition of FIN to standard of care (ie, angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker) among patients with diabetic nephropathy demonstrated a dose-dependent reduction in the urinary albumin-creatinine ratio over 90 days.…”