Bakris George, Agiro Abiy, Mu Fan, Cook Erin E, Greatsinger Alexandra, Sundar Manasvi, Guo Helen, Louden Elaine, Colman Ellen, Desai Pooja
AHA Comprehensive Hypertension Center, University of Chicago, Chicago, Illinois, USA.
AstraZeneca, Wilmington, Delaware, USA.
JACC Adv. 2024 Oct 14;3(11):101331. doi: 10.1016/j.jacadv.2024.101331. eCollection 2024 Nov.
Hyperkalemia (HK) has been linked to serious cardiovascular (CV) outcomes, but the impact of recurrent HK on these outcomes is ill-defined.
This study evaluated mortality and CV outcomes associated with recurrent HK vs normokalemia in patients with chronic kidney disease (CKD) and in a subset of patients with co-occurring heart failure (HF).
REVOLUTIONIZE III was a retrospective cohort study of adults (aged ≥18 years) diagnosed with stage 3/4 CKD, with or without HF in Optum's deidentified Market Clarity database (January 2016 to August 2022). Patients with recurrent HK (≥2 events) were exactly and propensity score-matched to patients with normokalemia (no serum [K+] <3.5 or >5.0 mmol/L or HK diagnosis ever). The primary endpoint was all-cause mortality; secondary endpoints were CV outcomes including major adverse CV events plus (major adverse cardiovascular event or hospitalization with heart failure [MACE+]; defined as all-cause mortality or hospitalized myocardial infarction, stroke, or HF and hospitalized arrhythmia). Cause-specific Cox proportional hazard models were used to compare outcomes between cohorts.
The study included 6,337 matched pairs overall, including 2,129 with HF. Characteristics of the samples were well-balanced. Recurrent HK was associated with higher risks of all-cause mortality (HR overall: 1.29 [95% CI: 1.20-1.38]; HF substudy: 1.30 [95% CI: 1.18-1.44]), MACE+ (overall: 1.53 [95% CI: 1.43-1.65]; HF substudy: 1.45 [95% CI: 1.29-1.64]), and hospitalized arrhythmia (overall: 1.94 [95% CI: 1.74-2.16]; HF substudy: 1.85 [95% CI: 1.55-2.21]) compared with normokalemia.
In patients with CKD, recurrent HK increased the risks of all-cause mortality, MACE+, and hospitalized arrhythmia compared with normokalemia, including in a subset of patients with HF.
高钾血症（HK）与严重心血管（CV）结局相关，但复发性HK对这些结局的影响尚不明确。
本研究评估了慢性肾脏病（CKD）患者以及合并心力衰竭（HF）的部分患者中，复发性HK与正常血钾水平相比的死亡率和CV结局。
REVOLUTIONIZE III是一项针对Optum公司匿名化的市场清晰度数据库（2016年1月至2022年8月）中诊断为3/4期CKD、有无HF的成年人（年龄≥18岁）的回顾性队列研究。复发性HK（≥2次事件）的患者与血钾正常（血清[K+]无<3.5或>5.0 mmol/L或从未有过HK诊断）的患者进行精确匹配和倾向评分匹配。主要终点是全因死亡率；次要终点是CV结局，包括主要不良CV事件加（主要不良心血管事件或因心力衰竭住院[MACE+]；定义为全因死亡率或住院心肌梗死、中风、HF和住院心律失常）。采用特定病因的Cox比例风险模型比较队列间的结局。
该研究共纳入6337对匹配病例，其中2129例合并HF。样本特征均衡。与正常血钾相比，复发性HK与全因死亡率（总体HR：1.29[95%CI：1.20 - 1.38]；HF亚组研究：1.30[95%CI：1.18 - 1.44]）、MACE+（总体：1.53[95%CI：1.43 - 1.65]；HF亚组研究：1.45[95%CI：1.29 - 1.64]）和住院心律失常（总体：1.94[95%CI：1.74 - 2.16]；HF亚组研究：1.85[95%CI：1.55 - 2.21]）风险更高相关。
在CKD患者中，与正常血钾相比，复发性HK增加了全因死亡率、MACE+和住院心律失常的风险，包括在部分合并HF的患者中。
