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Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis
- Source :
- European Heart Journal, 39, 17, pp. 1535-1542, European Heart Journal, 39(17), 1535-1542. Oxford University Press, European Heart Journal, 39, 1535-1542
- Publication Year :
- 2018
-
Abstract
- Item does not contain fulltext Aims: Both hypo- and hyperkalaemia can have immediate deleterious physiological effects, and 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 and results: We performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high cardiovascular risk, and 10 chronic kidney disease (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 estimated glomerular filtration rate (eGFR) and albuminuria. We included 1 217 986 participants followed up for a mean of 6.9 years. The average age was 55 +/- 16 years, average eGFR was 83 +/- 23 mL/min/1.73 m2, and 17% had moderate- to-severe increased albuminuria levels. The 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 of 4-4.5 mmol/L. Compared with a reference of 4.2 mmol/L, the adjusted hazard ratio for all-cause mortality was 1.22 [95% confidence interval (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.
- Subjects :
- Hyperkalemia
030232 urology & nephrology
HEMODIALYSIS-PATIENTS
Comorbidity
030204 cardiovascular system & hematology
GLOMERULAR-FILTRATION-RATE
HYPERKALEMIA
End-stage renal disease
CHRONIC RENAL-INSUFFICIENCY
0302 clinical medicine
SODIUM ZIRCONIUM CYCLOSILICATE
Risk Factors
Cause of Death
Estimated glomerular filtration rate
ESTIMATED GFR
education.field_of_study
Hazard ratio
Middle Aged
Prognosis
CHRONIC HEART-FAILURE
EUROPEAN-SOCIETY
Cardiovascular Diseases
medicine.symptom
Cardiology and Cardiovascular Medicine
Glomerular Filtration Rate
Adult
medicine.medical_specialty
Population
Renal function
Hypokalemia
End stage renal disease
03 medical and health sciences
Internal medicine
medicine
Humans
Albuminuria
Renal Insufficiency, Chronic
Mortality
education
CKD Prognosis Consortium
Aged
business.industry
Proportional hazards model
POLYMERIC POTASSIUM BINDER
medicine.disease
SERUM POTASSIUM
Potassium
Kidney Failure, Chronic
Renal disorders Radboud Institute for Health Sciences [Radboudumc 11]
business
Kidney disease
Subjects
Details
- Language :
- English
- ISSN :
- 0195668X
- Database :
- OpenAIRE
- Journal :
- European Heart Journal, 39, 17, pp. 1535-1542, European Heart Journal, 39(17), 1535-1542. Oxford University Press, European Heart Journal, 39, 1535-1542
- Accession number :
- edsair.doi.dedup.....dbce0a1431ef90a746ac9570b7394eab