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Prevalence of Hyperkalemia in Diabetic and Non-Diabetic Patients with Chronic Kidney Disease: A Nested Case-Control
Charalampos Loutradis1, Panagiota Tolika, Alexandra Skodra
1Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Insights
Hyperkalemia risk is elevated in diabetic patients with chronic kidney disease (CKD), particularly in Stage 3. Advanced CKD (Stage 4) and ACE inhibitor use are key factors for hyperkalemia.
Area of Science:
- Nephrology
- Endocrinology
- Internal Medicine
Background:
- Hyperkalemia is a serious complication of chronic kidney disease (CKD).
- The specific risk factors for hyperkalemia in diabetic versus non-diabetic CKD patients require further elucidation.
- Understanding these differences is crucial for managing CKD patients.
Purpose of the Study:
- To compare the prevalence of hyperkalemia in patients with type-2 diabetes and CKD versus non-diabetic patients with CKD.
- To identify factors associated with hyperkalemia in these patient groups.
Main Methods:
- A nested case-control study involving 180 type-2 diabetic and 180 non-diabetic CKD patients.
- Patients were matched for gender, age, and estimated glomerular filtration rate.
- Hyperkalemia was defined by serum potassium levels or medication use; logistic regression identified associated factors.
Main Results:
- Hyperkalemia prevalence was higher in diabetic CKD patients (27.2% vs. 20%), notably in Stage 3 (28.6% vs. 17.5%, p=0.036).
- No significant difference was observed in Stage 2 or Stage 4 CKD.
- Multivariate analysis identified Stage 4 CKD, angiotensin-converting enzyme inhibitor (ACEI) use, and smoking as independent predictors of hyperkalemia.
Conclusions:
- Diabetes mellitus increases hyperkalemia prevalence specifically in Stage 3 CKD patients.
- Advanced CKD (Stage 4) and ACEI use are significant determinants of hyperkalemia.
- These findings highlight the importance of tailored management strategies for hyperkalemia in CKD.
Background:
Hyperkalemia is a potentially life-threatening disorder, usually complicating chronic kidney disease (CKD). Factors superimposed to reduced renal function are further elevating hyperkalemia risk, but their contribution is not fully elucidated. This study aimed to compare the prevalence of hyperkalemia in diabetic and non-diabetic patients with CKD.
Methods:
This is a nested case-control study of 180 type-2 diabetic and 180 non-diabetic patients with CKD followed in a Nephrology outpatient clinic, matched for gender, age and estimated glomerular filtration rate. Type-1 diabetes or end-stage renal disease patients were excluded. Prevalence of hyperkalemia was defined as potassium >5 mEq/l or use of sodium polystyrene sulfonate, and further by potassium >5, ≥5.2 and ≥5.5 mEq/l. It was calculated in both groups in whole and CKD stages separately. Univariate and multivariate logistic regression analysis were conducted to identify factors associated with hyperkalemia.
Results:
The prevalence of hyperkalemia was higher in diabetic CKD patients (27.2 vs. 20%, p = 0.107) and remained around 30% higher with all secondary definitions used, but never reached statistical significance. In Stage 2, no difference was noted (8.7 vs. 17.4%, p = 0.665); in Stage 3, it was significantly higher in diabetics (28.6 vs. 17.5%, p = 0.036); and in Stage 4, it was equally high in both groups (35.5 vs. 32.3%, p = 0.788). In multivariate analysis, Stage 4 CKD (OR 4.535, 95% CI 1.561-13.173), use of angiotensin-converting enzyme inhibitors (ACEIs; OR 2.228, 95% CI 1.254-3.958) and smoking (OR 2.254, 95% CI 1.218-4.171) were independently associated with hyperkalemia.
Conclusions:
Diabetes mellitus was found to elevate the prevalence of hyperkalemia only in CKD Stage 3 patients (moderately impaired renal function). Advanced CKD at Stage 4 and ACEIs are major determinants of hyperkalemia occurrence.
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