학술논문
Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis.
Document Type
article
Author
Kovesdy, Csaba P; Matsushita, Kunihiro; Sang, Yingying; Brunskill, Nigel J; Carrero, Juan J; Chodick, Gabriel; Hasegawa, Takeshi; Heerspink, Hiddo L; Hirayama, Atsushi; Landman, Gijs WD; Levin, Adeera; Nitsch, Dorothea; Wheeler, David C; Coresh, Josef; Hallan, Stein I; Shalev, Varda; Grams, Morgan E; Astor, Brad; Appel, Larry; Greene, Tom; Chen, Teresa; Chalmers, John; Woodward, Mark; Arima, Hisatomi; Perkovic, Vlado; Djurdjev, Ognjenka; Zhang, Luxia; Liu, Lisheng; Zhao, Minghui; Wang, Fang; Wang, Jinwei; Tang, Mila; Iso, Hiroyasu; Yamagishi, Kazumasa; Umesawa, Mitsumasa; Muraki, Isao; Fukagawa, Masafumi; Maruyama, Shoichi; Hamano, Takayuki; Fujii, Naohiko; Wheeler, David; Emberson, John; Townend, John; Landray, Martin; Green, Jamie; Kirchner, H Lester; Chang, Alex R; Cirillo, Massimo; Jee, Sun Ha; Kimm, Heejin; Mok, Yejin; Wetzels, Jack FM; Blankestijn, Peter J; van Zuilen, Arjan D; Bots, M; Sarnak, Mark; Inker, Lesley; Roderick, Paul; Fletcher, Astrid; Bottinger, Erwin; Nadkarni, Girish N; Ellis, Stephen B; Nadukuru, Rajiv; Brunskill, Nigel; Major, Rupert; Shepherd, David; Medcalf, James; Gansevoort, Ron T; Bakker, Stephan JL; Heerspink, Hiddo J Lambers; Jassal, Simerjot K; Bergstrom, Jaclyn; Ix, Joachim H; Barrett-Connor, Elizabeth; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar; de Zeeuw, Dick; Brenner, Barry; Gasparini, Alessandro; Elinder, Carl-Gustaf; Barany, Peter; Evans, Marie; Segelmark, Mårten; Stendahl, Maria; Schön, Staffan; Tangri, Navdeep; Sud, Maneesh; Naimark, David; Wen, Chi-Pang; Tsao, Chwen-Keng
Source
European Heart Journal. 39(17)
Subject
Language
Abstract
AimsBoth 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 resultsWe 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.ConclusionsOutpatient potassium levels both above and below the normal range are consistently associated with adverse outcomes, with similar risk relationships across eGFR and albuminuria.