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Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project

BACKGROUND: Small-scale studies suggest that hyperkalaemia is a less threatening condition in chronic kidney disease (CKD), arguing adaptation/tolerance to potassium (K(+)) retention. This study formally evaluates this hypothesis by estimating the distribution of plasma K(+) and its association with...

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Autores principales: Gasparini, Alessandro, Evans, Marie, Barany, Peter, Xu, Hairong, Jernberg, Tomas, Ärnlöv, Johan, Lund, Lars H, Carrero, Juan-Jesús
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735645/
https://www.ncbi.nlm.nih.gov/pubmed/30085251
http://dx.doi.org/10.1093/ndt/gfy249
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author Gasparini, Alessandro
Evans, Marie
Barany, Peter
Xu, Hairong
Jernberg, Tomas
Ärnlöv, Johan
Lund, Lars H
Carrero, Juan-Jesús
author_facet Gasparini, Alessandro
Evans, Marie
Barany, Peter
Xu, Hairong
Jernberg, Tomas
Ärnlöv, Johan
Lund, Lars H
Carrero, Juan-Jesús
author_sort Gasparini, Alessandro
collection PubMed
description BACKGROUND: Small-scale studies suggest that hyperkalaemia is a less threatening condition in chronic kidney disease (CKD), arguing adaptation/tolerance to potassium (K(+)) retention. This study formally evaluates this hypothesis by estimating the distribution of plasma K(+) and its association with mortality across CKD stages. METHODS: This observational study included all patients undergoing plasma K(+) testing in Stockholm during 2006–11. We randomly selected one K(+) measurement per patient and constructed a cross-sectional cohort with mortality follow-up. Covariates included demographics, comorbidities, medications and estimated glomerular filtration rate (eGFR). We estimated K(+) distribution and defined K(+) ranges associated with 90-, 180- and 365-day mortality. RESULTS: Included were 831 760 participants, of which 70 403 (8.5%) had CKD G3 (eGFR <60–30 mL/min) and 8594 (1.1%) had CKD G4–G5 (eGFR <30 mL/min). About 66 317 deaths occurred within a year. Adjusted plasma K(+) increased across worse CKD stages: from median 3.98 (95% confidence interval 3.49–4.59) for eGFR >90 to 4.43 (3.22–5.65) mmol/L for eGFR ≤15 mL/min/1.73 m(2). The association between K(+) and mortality was U-shaped, but it flattened at lower eGFR strata and shifted upwards. For instance, the range where the 90-day mortality risk increased by no more than 100% was 3.45–4.94 mmol/L in eGFR >60 mL/min, but was 3.36–5.18  in G3 and 3.26–5.53 mmol/L in G4–G5. In conclusion, CKD stage modifies K(+) distribution and the ranges that predict mortality in the community. CONCLUSION: Although this study supports the view that hyperkalaemia is better tolerated with worse CKD, it challenges the current use of a single optimal K(+) range for all patients.
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spelling pubmed-67356452019-09-16 Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project Gasparini, Alessandro Evans, Marie Barany, Peter Xu, Hairong Jernberg, Tomas Ärnlöv, Johan Lund, Lars H Carrero, Juan-Jesús Nephrol Dial Transplant ORIGINAL ARTICLES BACKGROUND: Small-scale studies suggest that hyperkalaemia is a less threatening condition in chronic kidney disease (CKD), arguing adaptation/tolerance to potassium (K(+)) retention. This study formally evaluates this hypothesis by estimating the distribution of plasma K(+) and its association with mortality across CKD stages. METHODS: This observational study included all patients undergoing plasma K(+) testing in Stockholm during 2006–11. We randomly selected one K(+) measurement per patient and constructed a cross-sectional cohort with mortality follow-up. Covariates included demographics, comorbidities, medications and estimated glomerular filtration rate (eGFR). We estimated K(+) distribution and defined K(+) ranges associated with 90-, 180- and 365-day mortality. RESULTS: Included were 831 760 participants, of which 70 403 (8.5%) had CKD G3 (eGFR <60–30 mL/min) and 8594 (1.1%) had CKD G4–G5 (eGFR <30 mL/min). About 66 317 deaths occurred within a year. Adjusted plasma K(+) increased across worse CKD stages: from median 3.98 (95% confidence interval 3.49–4.59) for eGFR >90 to 4.43 (3.22–5.65) mmol/L for eGFR ≤15 mL/min/1.73 m(2). The association between K(+) and mortality was U-shaped, but it flattened at lower eGFR strata and shifted upwards. For instance, the range where the 90-day mortality risk increased by no more than 100% was 3.45–4.94 mmol/L in eGFR >60 mL/min, but was 3.36–5.18  in G3 and 3.26–5.53 mmol/L in G4–G5. In conclusion, CKD stage modifies K(+) distribution and the ranges that predict mortality in the community. CONCLUSION: Although this study supports the view that hyperkalaemia is better tolerated with worse CKD, it challenges the current use of a single optimal K(+) range for all patients. Oxford University Press 2019-09 2018-08-06 /pmc/articles/PMC6735645/ /pubmed/30085251 http://dx.doi.org/10.1093/ndt/gfy249 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle ORIGINAL ARTICLES
Gasparini, Alessandro
Evans, Marie
Barany, Peter
Xu, Hairong
Jernberg, Tomas
Ärnlöv, Johan
Lund, Lars H
Carrero, Juan-Jesús
Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project
title Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project
title_full Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project
title_fullStr Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project
title_full_unstemmed Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project
title_short Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project
title_sort plasma potassium ranges associated with mortality across stages of chronic kidney disease: the stockholm creatinine measurements (scream) project
topic ORIGINAL ARTICLES
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735645/
https://www.ncbi.nlm.nih.gov/pubmed/30085251
http://dx.doi.org/10.1093/ndt/gfy249
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