Agiro Abiy, Cook Erin, Mu Fan, Greatsinger Alexandra, Chen Jingyi, Zhao Angela, Louden Elaine, Colman Ellen, Desai Pooja, Chertow Glenn M
AstraZeneca, Wilmington, Delaware.
Analysis Group, Inc., Boston, Massachusetts.
Kidney360. 2024 Dec 1;5(12):1824-1834. doi: 10.34067/KID.0000000000000541. Epub 2024 Aug 9.
Hyperkalemia is a known complication of CKD; however, it is not known whether hyperkalemia directly contributes to CKD progression and risk of death. We found that patients with stages 3b/4 CKD and hyperkalemia had higher risk of CKD progression and death than matched patients without hyperkalemia.
Hyperkalemia is a known complication of CKD; however, it is not known whether hyperkalemia directly contributes to CKD progression and the risk of death. Clarifying the extent to which hyperkalemia is associated with CKD progression and mortality can inform clinical practice and guide future research. The objective of this study was to quantify the risks of CKD progression and mortality associated with hyperkalemia in patients with stages 3b/4 CKD.
This was a real-world, exact and propensity score matched, observational cohort study using data (January 2016 to December 2021) from Optum's deidentified Market Clarity Data, a large US integrated insurance claims/electronic medical record database. The study included matched adult patients with stages 3b/4 CKD with and without hyperkalemia, not regularly treated with an intestinal potassium (K) binder. Measured outcomes were CKD progression and all-cause mortality. CKD progression was defined as diagnosis of CKD stage 4 (if stage 3b at index), CKD stage 5 or kidney failure, or receipt of dialysis or kidney transplantation.
After matching, there were 6619 patients in each of the hyperkalemia and nonhyperkalemia cohorts, with a mean follow-up time of 2.12 (SD, 1.42) years. Use of any renin-angiotensin-aldosterone system inhibitors during baseline was common (75.9%), and most patients had CKD stage 3b (71.2%). Patients with hyperkalemia had a 1.60-fold (95% confidence interval, 1.50 to 1.71) higher risk of CKD progression and a 1.09-fold (1.02 to 1.16) higher risk of all-cause mortality relative to patients without hyperkalemia. Relative risks of CKD progression associated with hyperkalemia were similar within the subset of patients receiving renin-angiotensin-aldosterone system inhibitor, across CKD stages, and when alternative definitions of CKD progression were used.
Patients with CKD stages 3b/4 and hyperkalemia experienced significantly higher risks of CKD progression and all-cause mortality than propensity score matched patients without hyperkalemia.
高钾血症是慢性肾脏病（CKD）的一种已知并发症；然而，尚不清楚高钾血症是否直接导致CKD进展和死亡风险。我们发现，3b/4期CKD合并高钾血症的患者比匹配的无高钾血症患者有更高的CKD进展和死亡风险。
高钾血症是CKD的一种已知并发症；然而，尚不清楚高钾血症是否直接导致CKD进展和死亡风险。明确高钾血症与CKD进展及死亡率的关联程度可为临床实践提供参考并指导未来研究。本研究的目的是量化3b/4期CKD患者中与高钾血症相关的CKD进展和死亡风险。
这是一项基于现实世界、精确且倾向评分匹配的观察性队列研究，使用了Optum公司去识别化的市场清晰度数据（2016年1月至2021年12月），这是一个美国大型综合保险理赔/电子病历数据库。该研究纳入了匹配的成年3b/4期CKD患者，有高钾血症组和无高钾血症组，且未规律使用肠道钾（K）结合剂。测量的结局为CKD进展和全因死亡率。CKD进展定义为诊断为CKD 4期（若初始为3b期）、CKD 5期或肾衰竭，或接受透析或肾移植。
匹配后，高钾血症组和非高钾血症组各有6619例患者，平均随访时间为2.12（标准差，1.42）年。基线时使用任何肾素 - 血管紧张素 - 醛固酮系统抑制剂很常见（75.9%），且大多数患者为CKD 3b期（71.2%）。与无高钾血症的患者相比，高钾血症患者的CKD进展风险高1.60倍（95%置信区间，1.50至1.71），全因死亡风险高1.09倍（1.02至1.16）。在接受肾素 - 血管紧张素 - 醛固酮系统抑制剂的患者亚组中、跨CKD分期以及使用CKD进展的替代定义时，与高钾血症相关的CKD进展相对风险相似。
3b/4期CKD合并高钾血症的患者比倾向评分匹配的无高钾血症患者经历了显著更高的CKD进展和全因死亡风险。
