Current Management of Hyperkalemia in Non-Dialysis CKD: Longitudinal Study of Patients Receiving Stable Nephrology...

Area of Science:

• Nephrology
• Internal Medicine
• Cardiorenal Medicine

Background:

• Long-term management of hyperkalemia (HK) in outpatient chronic kidney disease (CKD) clinics has not been adequately studied.
• Understanding the limitations of current HK management is crucial for improving patient outcomes in CKD.
• Hyperkalemia is a common and serious complication in patients with CKD.

Purpose of the Study:

• To evaluate the association between current therapeutic options and serum potassium (sK) control over 12 months in non-dialysis-dependent CKD (ND-CKD) patients.
• To identify factors associated with persistent or new-onset hyperkalemia in CKD patients.
• To assess the effectiveness of current management strategies for hyperkalemia in CKD.

Main Methods:

• A 12-month observational study involving 562 ND-CKD patients stratified into four groups based on baseline and 12-month serum potassium levels (≥5.0 mEq/L).
• Evaluation of therapeutic options, including bicarbonate supplements, potassium binders, and non-potassium-sparing diuretics.
• Mixed-effects regression analysis to determine associations between sK levels and clinical factors, including eGFR, diabetes, and medication use.

Main Results:

• 17.1% of patients had persistent HK, and 16.6% developed new-onset HK over 12 months, despite adherence to dietary recommendations.
• Increased prescription of bicarbonate supplements (5.0% to 14.1%) and potassium binders (2.0% to 7.7%) was observed, but sK levels remained elevated in many.
• Higher sK levels were associated with lower eGFR, diabetes, lower serum bicarbonate, and reduced use of non-potassium-sparing diuretics; however, bicarbonate and K-binder use correlated with decreased sK.

Conclusions:

• A significant proportion of ND-CKD patients (approximately one-third) experience persistent or new-onset hyperkalemia despite current management strategies.
• Increased use of potassium-lowering drugs and adherence to dietary recommendations did not fully resolve hyperkalemia in many CKD patients.
• The findings highlight the limitations of current long-term hyperkalemia management in outpatient CKD settings, necessitating further research and improved therapeutic approaches.