Kidney Week

Abstract: TH-PO0076

Prevalence of Hyperkalemia in Patients with CKD: A Multicenter Study Based on Real-World Data

Session Information

• Fluid, Electrolyte, and Acid-Base Disorders: Clinical Research
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Fluid, Electrolytes, and Acid-Base Disorders

• 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

• Kim, Su Geun, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea (the Republic of)

Su Geun Kim, DrMed

• Bae, Eun Hui, Chonnam National University, Buk-gu, Gwangju, Korea (the Republic of)

Eun Hui Bae, MD, PhD

• Song, Su hyun, Chonnam National University, Buk-gu, Gwangju, Korea (the Republic of)

Su hyun Song, MD

• Lee, Hanbi, The Catholic University of Korea Seoul St Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)

Hanbi Lee, MD

• Ahn, Hyunjung, KakaoHealth Corp., Seongnam-si, Gyeonggi-do, Korea (the Republic of)

Hyunjung Ahn

• Jung, Sehwa, KakaoHealth Corp., Seongnam-si, Gyeonggi-do, Korea (the Republic of)

Sehwa Jung

• Park, Seokwoo, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea (the Republic of)

Seokwoo Park, MD, PhD

• Chung, Byung ha, The Catholic University of Korea Seoul St Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)

Byung ha Chung, MD, PhD

• Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea (the Republic of)

Sejoong Kim, MD, PhD

Background

Hyperkalemia remains a significant obstacle to the use of renin-angiotensin-aldosterone system inhibitors (RAASi) in patients with chronic kidney disease (CKD) and heart failure (HF). Existing data from trials or Western populations lack generalizability to real-world Asian settings. This study characterizes hyperkalemia prevalence and patterns across CKD stages using large-scale, multi-institutional Korean data.

Methods

This multicentre, retrospective observational study analyzed 553,418 adult patients with CKD diagnosed between October 2015 and September 2024. CKD was defined as an eGFR <60 mL/min/1.73m² or the presence of proteinuria or hematuria. Patients with prior kidney transplantation or hyperaldosteronism were excluded. The prevalence of hyperkalemia was assessed according to CKD stage, RAASi prescription status, and HF comorbidity.

Results

The prevalence of hyperkalemia among all CKD patients was 11.8%. This increased significantly with advancing CKD stage: 18.2% in Stage 3, 43.1% in Stage 4, and 55.3% in Stage 5 (P<.0001). RAASi users demonstrated 3.1-fold higher hyperkalemia risk compared to non-users (20.4% vs. 6.5%, p<.0001), with severe hyperkalemia (K⁺ ≥6.5 mEq/L) risk being 3.6-fold higher. HF comorbidity was associated with a significantly higher risk (26.0% vs. 10.6%, p<.0001). Among patients with normal baseline potassium levels, 9.0% developed hyperkalemia during follow-up; 14.5% of Stage 3 patients progressed, with 29.7% deteriorating within 3 months.

Conclusion

This large-scale, real-world study demonstrates a substantial hyperkalemia burden in Asian CKD patients, particularly among those with advanced CKD, RAASi treatment, or HF comorbidity. These findings support targeted hyperkalemia management strategies to optimize RAASi use and improve outcomes in CKD patients.

Acknowledgment

We thank the Korean Society of Nephrology (KSN) for providing access to the multicenter registry data. We also acknowledge all participating institutions and their clinical and data management teams for data collection and quality assurance. This study was conducted using de-identified real-world data; no additional funding or writing assistance was received for this abstract.

Funding

• Commercial Support – AstraZeneca Korea