Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2019
Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project.
СтатьяНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Gasparini Alessandro, Evans Marie, Barany Peter, Xu Hairong, Jernberg Tomas, Ärnlöv Johan, Lund Lars H, Carrero Juan-Jesús
Аннотация
BACKGROUND: Small-scale studies suggest that hyperkalaemia is a less threatening condition in chronic kidney disease (CKD), arguing adaptation/tolerance to potassium (K+) retention. This study formally evaluates this hypothesis by estimating the distribution of plasma K+ and its association with mortality across CKD stages.
METHODS: This observational study included all patients undergoing plasma K+ testing in Stockholm during 2006-11. We randomly selected one K+ measurement per patient and constructed a cross-sectional cohort with mortality follow-up. Covariates included demographics, comorbidities, medications and estimated glomerular filtration rate (eGFR). We estimated K+ distribution and defined K+ ranges associated with 90-, 180- and 365-day mortality.
RESULTS: Included were 831 760 participants, of which 70 403 (8.5%) had CKD G3 (eGFR <60-30 mL/min) and 8594 (1.1%) had CKD G4-G5 (eGFR <30 mL/min). About 66 317 deaths occurred within a year. Adjusted plasma K+ increased across worse CKD stages: from median 3.98 (95% confidence interval 3.49-4.59) for eGFR >90 to 4.43 (3.22-5.65) mmol/L for eGFR ≤15 mL/min/1.73 m2. The association between K+ and mortality was U-shaped, but it flattened at lower eGFR strata and shifted upwards. For instance, the range where the 90-day mortality risk increased by no more than 100% was 3.45-4.94 mmol/L in eGFR >60 mL/min, but was 3.36-5.18 in G3 and 3.26-5.53 mmol/L in G4-G5. In conclusion, CKD stage modifies K+ distribution and the ranges that predict mortality in the community.
CONCLUSION: Although this study supports the view that hyperkalaemia is better tolerated with worse CKD, it challenges the current use of a single optimal K+ range for all patients.
METHODS: This observational study included all patients undergoing plasma K+ testing in Stockholm during 2006-11. We randomly selected one K+ measurement per patient and constructed a cross-sectional cohort with mortality follow-up. Covariates included demographics, comorbidities, medications and estimated glomerular filtration rate (eGFR). We estimated K+ distribution and defined K+ ranges associated with 90-, 180- and 365-day mortality.
RESULTS: Included were 831 760 participants, of which 70 403 (8.5%) had CKD G3 (eGFR <60-30 mL/min) and 8594 (1.1%) had CKD G4-G5 (eGFR <30 mL/min). About 66 317 deaths occurred within a year. Adjusted plasma K+ increased across worse CKD stages: from median 3.98 (95% confidence interval 3.49-4.59) for eGFR >90 to 4.43 (3.22-5.65) mmol/L for eGFR ≤15 mL/min/1.73 m2. The association between K+ and mortality was U-shaped, but it flattened at lower eGFR strata and shifted upwards. For instance, the range where the 90-day mortality risk increased by no more than 100% was 3.45-4.94 mmol/L in eGFR >60 mL/min, but was 3.36-5.18 in G3 and 3.26-5.53 mmol/L in G4-G5. In conclusion, CKD stage modifies K+ distribution and the ranges that predict mortality in the community.
CONCLUSION: Although this study supports the view that hyperkalaemia is better tolerated with worse CKD, it challenges the current use of a single optimal K+ range for all patients.