Serum potassium and adverse outcomes across the range of kidney function

A CKD Prognosis Consortium meta-analysis

for the CKD Prognosis Consortium

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

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 We performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high car- and results diovascular 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 m 2 , 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.

Original languageEnglish (US)
Pages (from-to)1535-1542
Number of pages8
JournalEuropean Heart Journal
Volume39
Issue number17
DOIs
StatePublished - May 1 2018

Fingerprint

Chronic Renal Insufficiency
Meta-Analysis
Potassium
Albuminuria
Kidney
Glomerular Filtration Rate
Serum
Mortality
Confidence Intervals
Hyperkalemia
Hypokalemia
Chronic Kidney Failure
Reference Values
Outpatients
Demography
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Serum potassium and adverse outcomes across the range of kidney function : A CKD Prognosis Consortium meta-analysis. / for the CKD Prognosis Consortium.

In: European Heart Journal, Vol. 39, No. 17, 01.05.2018, p. 1535-1542.

Research output: Contribution to journalArticle

@article{54e00732e27740da992e2b534c07a55a,
title = "Serum potassium and adverse outcomes across the range of kidney function: A CKD Prognosis Consortium meta-analysis",
abstract = "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 We performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high car- and results diovascular 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 m 2 , 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.",
author = "{for the CKD Prognosis Consortium} and Kovesdy, {Csaba P.} and Kunihiro Matsushita and Yingying Sang and Brunskill, {Nigel J.} and Carrero, {Juan J.} and Csaba Kovesdy and Takeshi Hasegawa and Heerspink, {Hiddo L.} and Atsushi Hirayama and Landman, {Gijs W.D.} and Adeera Levin and Dorothea Nitsch and Wheeler, {David C.} and Josef Coresh and Hallan, {Stein I.} and Varda Shalev and Grams, {Morgan E.}",
year = "2018",
month = "5",
day = "1",
doi = "10.1093/eurheartj/ehy100",
language = "English (US)",
volume = "39",
pages = "1535--1542",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "17",

}

TY - JOUR

T1 - Serum potassium and adverse outcomes across the range of kidney function

T2 - A CKD Prognosis Consortium meta-analysis

AU - for the CKD Prognosis Consortium

AU - Kovesdy, Csaba P.

AU - Matsushita, Kunihiro

AU - Sang, Yingying

AU - Brunskill, Nigel J.

AU - Carrero, Juan J.

AU - Kovesdy, Csaba

AU - Hasegawa, Takeshi

AU - Heerspink, Hiddo L.

AU - Hirayama, Atsushi

AU - Landman, Gijs W.D.

AU - Levin, Adeera

AU - Nitsch, Dorothea

AU - Wheeler, David C.

AU - Coresh, Josef

AU - Hallan, Stein I.

AU - Shalev, Varda

AU - Grams, Morgan E.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - 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 We performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high car- and results diovascular 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 m 2 , 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.

AB - 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 We performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high car- and results diovascular 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 m 2 , 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.

UR - http://www.scopus.com/inward/record.url?scp=85052306596&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052306596&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehy100

DO - 10.1093/eurheartj/ehy100

M3 - Article

VL - 39

SP - 1535

EP - 1542

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 17

ER -