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Hyperkalemia in pediatric chronic kidney disease
Katherine L Kurzinski1, Yunwen Xu2, Derek K Ng2
1Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA.
Pediatric Nephrology (Berlin, Germany)
|March 20, 2023
Summary
Hyperkalemia is more common in children with advanced chronic kidney disease (CKD), particularly those with glomerular disease, low CO2, or on ACEi/ARB therapy. Identifying these risk factors aids in early intervention for pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Clinical Research
Background:
- Hyperkalemia is a known complication in adult chronic kidney disease (CKD).
- Limited large-scale studies exist on potassium trends and hyperkalemia risk factors in pediatric CKD.
- This study addresses the gap in understanding hyperkalemia in children with CKD.
Purpose of the Study:
- To characterize the prevalence of hyperkalemia in pediatric CKD patients.
- To identify specific risk factors associated with hyperkalemia in this population.
- To inform clinical practice for managing potassium levels in children with CKD.
Main Methods:
- Cross-sectional analysis of data from the Chronic Kidney Disease in Children (CKiD) cohort.
- Evaluation of median potassium levels and hyperkalemia incidence (K ≥5.5 mmoL/L).
- Logistic regression analysis to determine risk factors, including demographics, CKD stage, etiology, proteinuria, and acid-base status.
Main Results:
- Hyperkalemia was associated with low CO2 (OR 7.72), advanced CKD stage 4/5 (OR 9.17), and ACEi/ARB therapy (OR 2.14).
- Children with CKD stage 4/5 had a higher incidence of hyperkalemia (6.6% of participants, 14.3% of visits).
- Non-glomerular disease was associated with lower hyperkalemia risk (OR 0.52); age, sex, and race/ethnicity were not significant factors.
Conclusions:
- Hyperkalemia in pediatric CKD is linked to advanced disease stage, glomerular etiology, low CO2, and ACEi/ARB use.
- These findings help clinicians identify children at higher risk for hyperkalemia.
- Early identification can guide the initiation of potassium-lowering therapies in pediatric CKD patients.
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