A Nomogram to Identify Hyperkalemia Risk in Patients with Advanced CKD

Area of Science:

• Nephrology
• Internal Medicine
• Cardiology

Background:

• Hyperkalemia is a frequent and dangerous complication in patients with chronic kidney disease (CKD).
• Predicting hyperkalemia risk is crucial for timely intervention in advanced CKD.
• Current risk stratification methods for hyperkalemia in CKD require improvement.

Purpose of the Study:

• To develop and validate a predictive nomogram for hyperkalemia (serum potassium ≥5.5 mmol/L) in advanced CKD patients.
• To identify key risk factors associated with hyperkalemia development within a 6-month period.
• To create a tool for risk assessment aiding clinical decision-making.

Main Methods:

• A retrospective cohort study involving 847 adult patients with predialysis advanced CKD (stage ≥3) from 2020-2021.
• Multivariable logistic regression was used to build a nomogram based on identified risk factors.
• The nomogram's performance was assessed using C-statistics, calibration curves, and decision curve analysis (DCA), with internal and external validation.

Main Results:

• Hyperkalemia occurred in 28% of patients within 6 months.
• Independent risk factors included older age (≥75 years), higher CKD stages, prior hyperkalemia (serum potassium ≥5.0 mmol/L within 3 months), and comorbidities (heart failure, diabetes, metabolic acidosis).
• The nomogram demonstrated good predictive performance with a C-statistic of 0.76, validated across multiple datasets.

Conclusions:

• A validated nomogram and online calculator can effectively assess 6-month hyperkalemia risk in advanced CKD.
• This tool can aid in identifying high-risk patients who may benefit from intensive monitoring and early intervention.
• The nomogram provides a valuable tool for managing hyperkalemia in CKD patients.