Wheeler, DC; Kovesdy, C; Matsushita, K; Sang, Y; Brunskill, NJ; Carrero, JJ; Chodick, G; ... Grams, ME; + view all Wheeler, DC; Kovesdy, C; Matsushita, K; Sang, Y; Brunskill, NJ; Carrero, JJ; Chodick, G; Hasegawa, T; Heerspoink, H; Kirayama, A; Landman, GWD; Coresh, J; Hallan, S; Shalev, V; Grams, ME; - view fewer (2018) Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis. European Heart Journal , 39 (17) pp. 1535-1542. 10.1093/eurheartj/ehy100.

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Abstract

Aims: Both hypo- and hyperkalemia can have immediate deleterious physiologic effects; less is known about long-term risks. The objective was to determine the risks of all-cause mortality, cardiovascular mortality and end-stage renal disease associated with potassium levels across the range of kidney function and evaluate for consistency across cohorts in a global consortium. Methods & Results: We performed an individual-level data meta-analysis of 27 international cohorts (10 general population, 7 high cardiovascular risk, and 10 CKD) in the CKD Prognosis Consortium. We used Cox regression followed by random-effects meta-analysis to assess the relationship between baseline potassium and adverse outcomes, adjusted for demographic and clinical characteristics, overall and across strata of eGFR and albuminuria. We included 1,217,986 participants followed for a mean of 6.9 years. Average age was 55±16 years, average eGFR was 83±23 ml/min/1.73 m2, and 17% had moderate- to severely-increased albuminuria. Mean baseline potassium was 4.2±0.4 mmol/L. The risk of serum potassium of >5.5 mmol/L was related to lower eGFR and higher albuminuria. The risk-relationship between potassium levels and adverse outcomes was U-shaped with the lowest risk at serum potassium 4-4.5 mmol/L. Compared to a reference of 4.2 mmol/L, the adjusted hazard ratio for all-cause mortality was 1.22 (95% CI: 1.15-1.29) at 5.5 mmol/L and 1.49 (95% CI: 1.26-1.76) at 3.0 mmol/L. Risks were similar by eGFR, albuminuria, renin-angiotensin-aldosterone system inhibitor use, and across cohorts. Conclusions: Outpatient potassium levels both above and below the normal range are consistently associated with adverse outcomes, with similar risk relationships across eGFR and albuminuria.

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