The Effect of Different Serum Potassium Levels on Progression of Chronic Kidney Disease

Abstract

Objective: Hyperkalemia is the most commonelectrolyte imbalance in chronic kidney disease (CKD). Research within the CKD population suggests a potential link between hyperkalemia, hypokalemia, fluctuations in serum potassium (sK+) levels, and CKD progression.This study aimed to clarify how different sK+ levels affect CKD progression. Material and Methods:eGFR levels were assessed, identifying patients with decreased eGFR. A total of 1171 patients were included .sK+ levels were analyzed in groups, and a Binary Logistic Regression model was employed for GFR decrease prediction. Results: The mean sK+ level was 4.6 ± 0.4 mmol/l. Hyperkalemia was observed in 26.1% of patients, with hypokalemia at only 0.6%. During the follow-up, eGFR levels exhibited a significant decrease. A negative correlation was observed between sK+ level and the final eGFR of patients. Specifically, sK+ levels ranging from 5.0 to 5.5 mmol/l and instances of hyperkalemia were linked with decreased eGFR, while sK+ levels at 3.5-4.0 mmol/l demonstrated a protective effect against eGFR decrease. Adjusting for albumin, calcium, urea levels, ACEi/ARB usage, β-AR blockers intake, and CCB administration in the regression model revealed that sK+ levels at 5.0-5.5 mmol/l and hyperkalemia independently contributed to eGFR decrease. Conversely, sK+ levels at 3.5-4.0 mmol/l emerged as a protective factor against eGFR decrease. Conclusion: Our findings underscore the association of hyperkalemia and sK+ levels at 5.0-5.5 mmol/l with decreased eGFR among CKD patients. Conversely, maintaining sK+ levels at 3.5-4.0 mmol/l appears to mitigate the risk of eGFR decrease. Thus, vigilant sK+ monitoring is crucial in managing CKD effectively.

Keywords

• Chronic Kidney Disease
• Glomerular filtration rate
• Potassium Level
• Hyperkalemia
• Hypokalemia

Farklı Serum Potasyum Düzeylerinin Kronik Böbrek Hastalığının İlerlemesi Üzerindeki Etkisi

Öz

Amaç: Hiperkalemi, kronik böbrek hastalığında (KBH) en yaygın elektrolit dengesizliğidir. KBH popülasyonu içinde yapılan araştırmalar, hiperkalemi, hipokalemi, serum potasyum (sK+) seviyelerindeki dalgalanmalar ve KBH progresyonu arasında olası bir bağlantı olduğunu öne sürmektedir.Bu çalışma, farklı sK+ seviyelerinin kronik böbrek hastalığı (KBH) progresyonunu nasıl etkilediğini açıklığa kavuşturmayı amaçlamıştır. Gereç ve Yöntemler: eGFR seviyeleri değerlendirilerek eGFR’si azalmış hastalar belirlendi. Toplamda 1171 hasta dahil edildi. sK+ seviyeleri gruplar halinde analiz edildi ve GFR azalmasını öngörmek için İkili Lojistik Regresyon modeli kullanıldı. Bulgular: Ortalama sK+ seviyesi 4.6 ± 0.4 mmol/l idi. Hastaların %26.1'inde hiperkalemi, yalnızca %0.6'sında ise hipokalemi gözlendi. Takip süresince eGFR seviyelerinde önemli bir düşüş tespit edildi. sK+ seviyesi ile hastaların nihai eGFR'leri arasında negatif bir korelasyon ortaya çıktı. Özellikle, sK+ seviyeleri 5.0-5.5 mmol/l aralığında ve hiperkalemi durumları eGFR azalması ile ilişkili bulundu. Buna karşılık, sK+ seviyeleri 3.5-4.0 mmol/l aralığında olduğunda eGFR azalmasına karşı koruyucu bir etki gösterdi. Regresyon modeline albümin, kalsiyum, üre seviyeleri, ACEi/ARB kullanımı, β-AR bloker alımı ve CCB uygulaması dahil edilerek yapılan ayarlamalarda, sK+ seviyeleri 5.0-5.5 mmol/l ve hiperkaleminin bağımsız olarak eGFR azalmasına katkıda bulunduğu görüldü. Aksine, sK+ seviyeleri 3.5-4.0 mmol/l aralığında olduğunda eGFR azalmasına karşı koruyucu bir faktör olarak ortaya çıktı. Sonuç: Bulgularımız, hiperkalemi ve 5,0-5,5 mmol/l arasındaki sK+ seviyelerinin KBH hastalarında azalan eGFR ile ilişkili olduğunu vurgulamaktadır. Öte yandan, sK+ seviyelerinin 3,5-4,0 mmol/l arasında tutulması, eGFR azalma riskini azaltmada önemli bir faktör gibi görünmektedir. Dolayısıyla, dikkatli sK+ izlemi, KBH'yi etkili bir şekilde yönetmede önemlidir.

Anahtar Kelimeler

• Kronik Böbrek Hastalığı
• Glomerüler Filtrasyon Hızı
• Potasyum Seviyesi
• Hiperkalemi
• Hipokalemi

Kaynakça

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