Kidney Week

Abstract: TH-PO1030

Prevalence of Elevated Serum Potassium in CKD Population by KDIGO Risk and eGFR Categories in a Representative US Population: NHANES 1999-2018

Session Information

• CKD Epidemiology, Risk Factors, Prevention - I
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Singh, Ajay K., Brigham and Women's Hospital, Boston, Massachusetts, United States

Ajay K. Singh,

• Zheng, Zihe, Brigham and Women's Hospital, Boston, Massachusetts, United States

Zihe Zheng,

• Farag, Youssef MK, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States

Youssef MK Farag,

Background

Among patients with CKD, hyperkalemia has been independently associated with poorer outcomes. However, the prevalence, risk factors, and severity of hyperkalemia in the US by demographic groups, KDIGO risk categories, eGFR categories and levels of albuminuria have not been reported.

Methods

We used data of 101,316 participants from the National Health and Nutrition Examination Survey (NHANES) between 1999 to 2018. We calculated 20-year weights to account for the complex survey design and the oversampling of certain age and minority groups. We defined and examined hyperkalemia by different levels of elevated serum potassium > 5.0, >5.5, and >6 mmol/L. Univariate and multivariate regression analysis was performed to identify independent predictors for hyperkalemia. Each model was adjusted for age, gender, race/ethnicity, diastolic blood pressure, hypertension, diabetes, HbA1c, hemoglobin, triglyceride, and CVD history. In the model of eGFR as exposure, UACR was additionally adjusted and in the model of UACR as exposure, eGFR was additionally adjusted.

Results

In a nationally representative sample of US adults with CKD, the prevalence of mild hyperkalemia (K>5.0 mmol/L) was 2.46%, moderate hyperkalemia (K>5.5 mmol/L) was 0.43%, and severe hyperkalemia (K>6 mmol/L) was rare at 0.06% (Table). While mild hyperkalemia was common in patients with KDIGO very high-risk category (9.72%) and in eGFR <15 to 29 ml/min/1.73m² (15.67%), severe hyperkalemia was rare at 0.54% and 1.45%, respectively. Both KDIGO risk and eGFR categories independently predicted mild and moderate hyperkalemia.

Conclusion

Mild hyperkalemia is relatively common in patients with advanced CKD, although not as high as previously reported in unweighted samples of CKD patients. Severe hyperkalemia is rare. The most important predictors of hyperkalemia are high and very high KDIGO risk categories as well as eGFR of <15-29 ml/min/1.73m².

^¶ Rare event, no observation.