Kidney Week

Abstract: FR-PO0575

The Hidden Cardiorenal Risk of Borderline Hyperkalemia (5.0-5.4 mmol/L): An Analysis from the C-STRIDE Study

Session Information

• CKM: Clinical - Meta-Analyses, Predictive Modeling, Care Delivery, and Safety
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Wang, Jinwei, Peking University First Hospital, Beijing, China

Jinwei Wang, PhD

• Zhang, Luxia, Peking University First Hospital, Beijing, China

Luxia Zhang, MD, MPH

• Zhao, Minghui, Peking University First Hospital, Beijing, China

Minghui Zhao, PhD

Group or Team Name

• C-STRIDE study group

Background

Hyperkalemia has been demonstrated to be a risk factor for cardiovascular death and kidney failure among patients with chronic kidney disease (CKD). However, the association with more general events, such as major adverse cardiovascular events (MACE), was lacking. We aimed to evaluate the association between hyperkalemia and cardiorenal events among patients with CKD stages 1-4.

Methods

This study was conducted based on the multicenter Chinese Cohort Study of CKD (C-STRIDE). Participants with baseline and at least one follow-up measurement of serum potassium during 2-year after baseline were included in the analysis. The exposure was the incidence of hyperkalemia during the time window. The outcomes included incident MACE, MACE plus cardiac dysrhythmia, kidney replacement therapy (KRT) and all-cause mortality. Cox proportional hazards regression was used to examine the association adjusting for age, sex, eGFR, hypertension, diabetes, cardiovascular disease history, RAAS inhibitor use, potassium-lowering resin use, potassium-wasting diuretics use, etiology of CKD, and log-transformed urinary albumin-to-creatinine ratio.

Results

Totally, 2,233 patients were included in the analysis with mean age of 50.8±14.5 years, 56.3% of male and mean eGFR of 49.8±29.6 ml/min/1.73m². CKD stages 3-4 accounted for 70.1% of patients. The proportions of using RAAS inhibitor, potassium-lowering resin and potassium-wasting diuretics at baseline were 58.2%, 2.9% and 9.4%, respectively. During the 2-year time window, patients had a median of 3 measurements (interquartile range: 2-7) of serum potassium and 18.5% of them had that of 5.0-5.4 mmol/L happened while 17.7% had ≥5.5 mmol/L happened. Over 4.0 [3.2-4.7] years of follow-up afterwards, 93 MACE, 102 MACE plus cardiac dysrhythmia, 311 KRT and 80 all-cause mortality occurred. Only serum potassium of 5.0-5.4 mmol/L was associated with MACE and MACE plus cardiac dysrhythmia (the respective hazard ratios were 1.76 [95% confidence interval: 1.08-2.87] and 1.69 [1.05-2.71]), instead of that of ≥5.5 mmol/L (the respective hazard ratios were 1.03 [0.56-1.90] and 1.16 [0.66-2.04]) in the fully adjusted model. No significant associations were detected for KRT and all-cause mortality.

Conclusion

Borderline hyperkalemia (5.0-5.4 mmol/L) was associated with risk of MACE and MACE plus cardiac dysrhythmia among patients with CKD.

Acknowledgment

None.