Valdivielso Jose M, Carriazo Sol, Martin Marisa, Fernandez-Fernandez Beatriz, Bermudez-López Marcelino, Ortiz Alberto
Vascular and Renal Translational Research Group, UDETMA, REDinREN del ISCIII, IRBLleida, University of Lleida, Lleida, Spain.
IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and REDINREN, Madrid, Spain.
Clin Kidney J. 2023 Oct 9;17(1):sfad212. doi: 10.1093/ckj/sfad212. eCollection 2024 Jan.
Hyperkalemia is common among patients with chronic kidney disease (CKD) but there is scarce information on differential risk factors and outcomes for men and women. For instance, smoking has been suggested to be a risk factor for hyperkalemia, but specific analysis of the sex-specific impact of smoking on hyperkalemia in CKD is lacking.
We studied serum potassium levels in 2891 participants from the NEFRONA cohort: 483 controls (47% women) and 2408 CKD patients (38% women) without prior cardiovascular disease (CVD), assessing whether smoking is a risk factor for hyperkalemia, and if hyperkalemia is associated with outcomes separately for men and women.
Median potassium levels and prevalence of hypo and hyperkalemia were higher in CKD participants than in controls. Serum potassium levels were higher and hyperkalemia and severe hyperkalemia more prevalent in men than in women with non-dialysis CKD (G3-G5). The highest prevalence of hyperkalemia for each gender was found in CKD G4-G5 and hemodialysis patients for men (46%) and in hemodialysis (54%) for women. Gender-specific etiological multivariate analysis identified current smoking as a risk factor for hyperkalemia only in men. Hyperkalemia was independently associated with stopping RAASi, an outcome which was more common in women. Hyperkalemia was also associated to higher risk of cardiovascular events within 4 years in men. In conclusion, hyperkalemia is common among men and women with CKD, but the prevalence, risk factors and outcomes may differ by gender. Specifically, current smoking is a driver of hyperkalemia in men.
高钾血症在慢性肾脏病（CKD）患者中很常见，但关于男性和女性的不同危险因素及预后的信息却很少。例如，吸烟被认为是高钾血症的一个危险因素，但缺乏对吸烟对CKD患者高钾血症的性别特异性影响的具体分析。
我们研究了NEFRONA队列中2891名参与者的血清钾水平：483名对照者（47%为女性）和2408名无心血管疾病（CVD）病史的CKD患者（38%为女性），评估吸烟是否为高钾血症的危险因素，以及高钾血症与男性和女性的预后是否分别相关。
CKD参与者的血钾中位数水平以及低钾血症和高钾血症的患病率均高于对照者。非透析CKD（G3-G5）男性的血清钾水平更高，高钾血症和严重高钾血症的患病率也高于女性。男性CKD G4-G5和血液透析患者中高钾血症的患病率最高（46%），女性则在血液透析患者中最高（54%）。性别特异性病因多因素分析确定，目前吸烟仅在男性中是高钾血症的危险因素。高钾血症与停用肾素-血管紧张素-醛固酮系统抑制剂（RAASi）独立相关，这一结局在女性中更常见。高钾血症还与男性4年内发生心血管事件的较高风险相关。总之，高钾血症在患有CKD的男性和女性中都很常见，但患病率、危险因素和预后可能因性别而异。具体而言，目前吸烟是男性高钾血症的一个驱动因素。
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