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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Epidemiology of hyperkalemia in chronic kidney disease
Lara Belmar Vega1, Emilio Rodrigo Galabia1, Jairo Bada da Silva1
1Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
Insights
Hyperkalaemia is common in chronic kidney disease (CKD), often exacerbated by beneficial Renin-angiotensin-aldosterone system inhibitors (RAASi). New potassium binders may help maintain RAASi benefits in CKD patients.
Area of Science:
- Nephrology
- Internal Medicine
- Clinical Pharmacology
Background:
- Hyperkalaemia is a critical electrolyte imbalance in chronic kidney disease (CKD).
- Renin-angiotensin-aldosterone system inhibitors (RAASi) offer cardio-renal benefits but frequently cause hyperkalaemia.
- Managing hyperkalaemia is crucial for CKD patients, especially those on RAASi therapy.
Purpose of the Study:
- To determine the prevalence of hyperkalaemia in CKD patients.
- To identify risk factors associated with hyperkalaemia in CKD.
- To investigate the relationship between hyperkalaemia and mortality in CKD.
Main Methods:
- A retrospective observational study of 2,629 CKD patients from 1971-2017.
- Patients were categorized into three groups: non-dialysis CKD, haemodialysis, and peritoneal dialysis.
- Analysis of risk factors including GFR, creatinine, sodium, haemoglobin, blood pressure, and medication use.
Main Results:
- Hyperkalaemia prevalence was 9.6% (non-dialysis), 16.4% (haemodialysis), and 10.6% (peritoneal dialysis).
- Key risk factors included lower GFR, higher creatinine, lower sodium, lower haemoglobin, higher diastolic blood pressure, RAASi use, metformin, and diabetes.
- RAASi use significantly increased hyperkalaemia risk with decreased GFR, and in diabetic or heart failure patients.
Conclusions:
- Hyperkalaemia is frequent in CKD and is exacerbated by RAASi, potentially limiting their use.
- New non-absorbable potassium binders that enhance faecal excretion may preserve RAASi benefits.
- These novel agents could be significant in managing CKD patients requiring RAASi therapy.
Background:
Hyperkalaemia is a significant electrolyte imbalance in chronic kidney disease (CKD). Renin-angiotensin-aldosterone system inhibitors (RAASi) have beneficial cardio-renal properties, although they can often cause hyperkalaemia.
Objective:
To examine the prevalence of hyperkalaemia in CKD, identify factors associated with its appearance and the relationship between hyperkalaemia and mortality.
Patients And Methods:
Retrospective observational study on patients with CKD in the period 1971-2017. The population was categorised into 3groups: Group 1, patients with CKD without renal replacement therapy; Group 2, patients on haemodialysis; and Group 3, patients on continuous ambulatory peritoneal dialysis.
Results:
A total of 2,629 patients were evaluated. The prevalence observed in the different groups was: 9.6%, 16.4% and 10.6%, respectively. Risk factors related to the appearance of hyperkalaemia in the CKD group were glomerular filtration rate (GFR) (P<.001), plasma creatinine (P<.001), plasma sodium (P<.001), haemoglobin (P=.028), diastolic blood pressure (P=.012), intake of ACE inhibitors and/or angiotensin ii receptor blockers (P=.008), treatment with metformin (P<.001) and diabetes (P=.045). Treatment with RAASi significantly increased hyperkalaemia as GFR decreased, as well as in patients with diabetes or heart failure.
Conclusions:
Hyperkalaemia is a frequent metabolic alteration in CKD patients that increases in the presence of drugs with beneficial cardio-renal properties (RAASi), which means that patients often lose the benefit associated with these drugs. New, recently-appearing non-absorbable compounds, which bind to potassium in the gastrointestinal tract, enhancing faecal excretion and thus maintaining the cardio-renal benefit of the RAASi, could be relevant in the progress of patients with CKD.
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