The Effect of Different Serum Potassium Levels on Progression of Chronic Kidney Disease

İvo Gökmen; Ömer Celal Elçioğlu

doi:10.53394/akd.1482691

Araştırma Makalesi

Farklı Serum Potasyum Düzeylerinin Kronik Böbrek Hastalığının İlerlemesi Üzerindeki Etkisi

Yıl 2025, Cilt: 11 Sayı: 2, 266 - 276, 28.05.2025

İvo Gökmen , Ömer Celal Elçioğlu

https://doi.org/10.53394/akd.1482691

Öz

Amaç: Hiperkalemi, kronik böbrek hastalığında (KBH) en yaygın elektrolit dengesizliğidir. KBH popülasyonu içinde yapılan araştırmalar, hiperkalemi, hipokalemi, serum potasyum (sK+) seviyelerindeki dalgalanmalar ve KBH progresyonu arasında olası bir bağlantı olduğunu öne sürmektedir.Bu çalışma, farklı sK+ seviyelerinin kronik böbrek hastalığı (KBH) progresyonunu nasıl etkilediğini açıklığa kavuşturmayı amaçlamıştır.
Gereç ve Yöntemler: eGFR seviyeleri değerlendirilerek eGFR’si azalmış hastalar belirlendi. Toplamda 1171 hasta dahil edildi. sK+ seviyeleri gruplar halinde analiz edildi ve GFR azalmasını öngörmek için İkili Lojistik Regresyon modeli kullanıldı.
Bulgular: Ortalama sK+ seviyesi 4.6 ± 0.4 mmol/l idi. Hastaların %26.1'inde hiperkalemi, yalnızca %0.6'sında ise hipokalemi gözlendi. Takip süresince eGFR seviyelerinde önemli bir düşüş tespit edildi. sK+ seviyesi ile hastaların nihai eGFR'leri arasında negatif bir korelasyon ortaya çıktı. Özellikle, sK+ seviyeleri 5.0-5.5 mmol/l aralığında ve hiperkalemi durumları eGFR azalması ile ilişkili bulundu. Buna karşılık, sK+ seviyeleri 3.5-4.0 mmol/l aralığında olduğunda eGFR azalmasına karşı koruyucu bir etki gösterdi. Regresyon modeline albümin, kalsiyum, üre seviyeleri, ACEi/ARB kullanımı, β-AR bloker alımı ve CCB uygulaması dahil edilerek yapılan ayarlamalarda, sK+ seviyeleri 5.0-5.5 mmol/l ve hiperkaleminin bağımsız olarak eGFR azalmasına katkıda bulunduğu görüldü. Aksine, sK+ seviyeleri 3.5-4.0 mmol/l aralığında olduğunda eGFR azalmasına karşı koruyucu bir faktör olarak ortaya çıktı.
Sonuç: Bulgularımız, hiperkalemi ve 5,0-5,5 mmol/l arasındaki sK+ seviyelerinin KBH hastalarında azalan eGFR ile ilişkili olduğunu vurgulamaktadır. Öte yandan, sK+ seviyelerinin 3,5-4,0 mmol/l arasında tutulması, eGFR azalma riskini azaltmada önemli bir faktör gibi görünmektedir. Dolayısıyla, dikkatli sK+ izlemi, KBH'yi etkili bir şekilde yönetmede önemlidir.

Anahtar Kelimeler

Kronik Böbrek Hastalığı, Glomerüler Filtrasyon Hızı, Potasyum Seviyesi, Hiperkalemi, Hipokalemi

Kaynakça

1. Süleymanlar G, Utaş C, ArinsoyT, Ateş K, AltunB, Altiparmak MR, Ecder T, Yilmaz ME, Çamsari T, BaşciA, Odabaş AR, Serdengecti K. Population-based survey of Chronic Renal Disease In Turkey--the CREDIT study. Nephrol Dial Transplant 2011; 26(6):1862-71.
2. Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health 2008; 8:117.
3. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395(10225):709-33.
4. USRDS 2017 annual data report: US Renal Data System; 2017 [Internet]. Available from: (Available from: https://www.usrds.org/2017/view/Default.aspx.)
5. Mirzapoor AZ, Hamedi AD, Rahmani B, Shahbadori R, Karami S, Peymani A, Taghizadeh S, Samiee RF. KRAS, NRAS, BRAF, and PIK3CA mutation rates, clinicopathological association, and their prognostic value in Iranian colorectal cancer patients. J Clin Lab Anal 2023; 37(5):e24868.
6. Stanton BA. Renal potassium transport: morphological and functional adaptations. Am J Physiol 1989; 257(5 Pt 2):R989-97.
7. Momoniat T, Ilyas D, Bhandari S. ACE inhibitors and ARBs: Managing potassium and renal function. Cleve Clin J Med 2019; 86(9):601-7.
8. Zillich AJ, Garg J, Basu S, Bakris GL, Carter BL. Thiazide diuretics, potassium, and the development of diabetes: a quantitative review. Hypertension 2006; 48(2):219-24.
9. Hayes J, Kalantar ZK, Lu JL, Turban S, Anderson JE, Kovesdy CP. Association of hypo- and hyperkalemia with disease progression and mortality in males with chronic kidney disease: the role of race. Nephron Clin Pract 2012; 120(1):c8-16.
10. Einhorn LM, Zhan M, Hsu VD, Walker LD, Moen MF, Seliger SL, Weir MR, Fink JC. The frequency of hyperkalemia and its significance in chronic kidney disease. Arch Intern Med 2009; 169(12):1156-62.
11. Korgaonkar S, Tilea A, Gillespie BW, Kiser M, Eisele G, Finkelstein F, Kotanko P, Pitt B, Saran R. Serum potassium and outcomes in CKD: insights from the RRI-CKD cohort study. Clin J Am Soc Nephrol 2010; 5(5):762-9.
12. Nakhoul GN, Huang H, Arrigain S, Jolly SE, Schold JD, Nally JV, Navaneethan SD. Serum Potassium, End-Stage Renal Disease and Mortality in Chronic Kidney Disease. Am J Nephrol 2015; 41(6):456-63.
13. Luo J, Brunelli SM, Jensen DE, Yang A. Association between Serum Potassium and Outcomes in Patients with Reduced Kidney Function. Clin J Am Soc Nephrol 2016; 11(1):90-100.
14. Xie P, Huang JM, Lin HY, Wu WJ, Pan LP. CDK-EPI equation may be the most proper formula based on creatinine in determining glomerular filtration rate in Chinese patients with chronic kidney disease. Int Urol Nephrol 2013; 45(4):1057-64.
15. Schlüter K, Cadamuro J. Erroneous potassium results: preanalytical causes, detection, and corrective actions. Crit Rev Clin Lab Sci 2023; 60(6):442-65.
16. Perez GO, Oster JR, Vaamonde CA. Serum potassium concentration in acidemic states. Nephron 1981; 27(4-5):233-43.
17. Palmer BF. Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med 2004; 351(6):585-92.
18. Unruh ML, Evans IV, Fink NE, Powe NR, Meyer KB. Skipped treatments, markers of nutritional nonadherence, and survival among incident hemodialysis patients. Am J Kidney Dis 2005; 46(6):1107-16.
19. Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990; 15(5):458-82.
20. Takaichi K, Takemoto F, Ubara Y, Mori Y. The clinically significant estimated glomerular filtration rate for hyperkalemia. Intern Med 2008; 47(14):1315-23.
21. Hsieh MF, Wu IW, Lee CC, Wang SY, Wu MS. Higher serum potassium level associated with late stage chronic kidney disease. Chang Gung Med J 2011; 34(4):418-25.
22. Gennari FJ, Segal AS. Hyperkalemia: An adaptive response in chronic renal insufficiency. Kidney Int 2002; 62(1):1-9.
23. Tanaka K, Saito H, Iwasaki T, Oda A, Watanabe S, Kanno M, Kimura H, Shimabukuro M, Asahi K, Watanabe T, Kazama JJ.Association between serum potassium levels and adverse outcomes in chronic kidney disease: the Fukushima CKD cohort study. Clin Exp Nephrol 2021; 25(4):410-7.
24. Molin CZD, Trevisol DJ. Persistent severe hypokalemia: Gitelman syndrome and differential diagnosis. J Bras Nefrol 2017; 39(3):337-40.
25. Yang J, Zhang X, Yu X, Tang W, Gan H. Renin-angiotensin system activation accelerates atherosclerosis in experimental renal failure by promoting endoplasmic reticulum stress-related inflammation. Int J Mol Med 2017; 39(3):613-21.
26. de Rooij ENM, de Fijter JW, Le Cessie S, Hoorn EJ, Jager KJ, Chesnaye NC, Evans M, Windahl K, Caskey FJ, Torino C, Szymczak M, Drechsler C, Wanner C, Dekker FW, Hoogeveen EK. Serum Potassium and Risk of Death or Kidney Replacement Therapy in Older People With CKD Stages 4-5: Eight-Year Follow-up. Am J Kidney Dis 2023; 82(3):257-66.e1.
27. Kovesdy CP, Matsushita K, Sang Y, Brunskill NJ, Carrero JJ, Chodick G, Hasegawa T, Heerspink HL, Hirayama A, Landman GWD, Levin A, Nitsch D, Wheeler DC, Coresh J, Hallan SI, Shalev V, Grams ME. Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis. Eur Heart J 2018; 39(17):1535-42.
28. de Zeeuw D, Akizawa T, Audhya P, Bakris GL, Chin M, Christ SH, Goldsberry A, Houser M, Krauth M, Lambers HJ, McMurray JJ, Meyer CJ, Parving HH, Remuzzi G, Toto RD, Vaziri ND, Wanner C, Wittes J, Wrolstad D, Chertow GM. Bardoxolone methyl in type 2 diabetes and stage 4 chronic kidney disease. N Engl J Med 2013; 369(26):2492-503.
29. Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, Wanner C, Krane V, Cass A, Craig J, Neal B, Jiang L, Hooi LS, Levin A, Agodoa L, Gaziano M, Kasiske B, Walker R, Massy ZA, Feldt RB, Krairittichai U, Ophascharoensuk V, Fellström B, Holdaas H, Tesar V, Wiecek A, Grobbee D, de Zeeuw D, Grönhagen RC, Dasgupta T, Lewis D, Herrington W, Mafham M, Majoni W, Wallendszus K, Grimm R, Pedersen T, Tobert J, Armitage J, Baxter A, Bray C, Chen Y, Chen Z, Hill M, Knott C, Parish S, Simpson D, Sleight P, Young A, Collins R. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 2011; 377(9784):2181-92.
30. Ohno S, Ishii A, Yanagita M, Yokoi H. Calcium channel blocker in patients with chronic kidney disease. Clin Exp Nephrol 2022; 26(3):207-15.
31. Thomsen RW, Nicolaisen SK, Hasvold P, Sanchez RG, Pedersen L, Adelborg K, Egstrup K, Egfjord M, Sørensen HT. Elevated potassium levels in patients with chronic kidney disease: occurrence, risk factors and clinical outcomes-a Danish population-based cohort study. Nephrol Dial Transplant 2018; 33(9):1610-20.
32. Kovesdy CP. Management of Hyperkalemia: An Update for the Internist. Am J Med 2015; 128(12):1281-7.
33. Seliger SL. Hyperkalemia in patients with chronic renal failure. Nephrol Dial Transplant 2019; 34(Suppl 3):iii12-iii8.
34. Kim DW, Song SH. Sarcopenia in chronic kidney disease: from bench to bedside. Korean J Intern Med 2023; 38(3):303-21.

The Effect of Different Serum Potassium Levels on Progression of Chronic Kidney Disease

Yıl 2025, Cilt: 11 Sayı: 2, 266 - 276, 28.05.2025

İvo Gökmen , Ömer Celal Elçioğlu

https://doi.org/10.53394/akd.1482691

Öz

Objective: Hyperkalemia is the most commonelectrolyte imbalance in chronic kidney disease (CKD). Research within the CKD population suggests a potential link between hyperkalemia, hypokalemia, fluctuations in serum potassium (sK+) levels, and CKD progression.This study aimed to clarify how different sK+ levels affect CKD progression.
Material and Methods:eGFR levels were assessed, identifying patients with decreased eGFR. A total of 1171 patients were included .sK+ levels were analyzed in groups, and a Binary Logistic Regression model was employed for GFR decrease prediction.
Results: The mean sK+ level was 4.6 ± 0.4 mmol/l. Hyperkalemia was observed in 26.1% of patients, with hypokalemia at only 0.6%. During the follow-up, eGFR levels exhibited a significant decrease. A negative correlation was observed between sK+ level and the final eGFR of patients. Specifically, sK+ levels ranging from 5.0 to 5.5 mmol/l and instances of hyperkalemia were linked with decreased eGFR, while sK+ levels at 3.5-4.0 mmol/l demonstrated a protective effect against eGFR decrease. Adjusting for albumin, calcium, urea levels, ACEi/ARB usage, β-AR blockers intake, and CCB administration in the regression model revealed that sK+ levels at 5.0-5.5 mmol/l and hyperkalemia independently contributed to eGFR decrease. Conversely, sK+ levels at 3.5-4.0 mmol/l emerged as a protective factor against eGFR decrease.
Conclusion: Our findings underscore the association of hyperkalemia and sK+ levels at 5.0-5.5 mmol/l with decreased eGFR among CKD patients. Conversely, maintaining sK+ levels at 3.5-4.0 mmol/l appears to mitigate the risk of eGFR decrease. Thus, vigilant sK+ monitoring is crucial in managing CKD effectively.

Anahtar Kelimeler

Chronic Kidney Disease, Glomerular filtration rate, Potassium Level, Hyperkalemia, Hypokalemia

Kaynakça

1. Süleymanlar G, Utaş C, ArinsoyT, Ateş K, AltunB, Altiparmak MR, Ecder T, Yilmaz ME, Çamsari T, BaşciA, Odabaş AR, Serdengecti K. Population-based survey of Chronic Renal Disease In Turkey--the CREDIT study. Nephrol Dial Transplant 2011; 26(6):1862-71.
2. Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health 2008; 8:117.
3. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395(10225):709-33.
4. USRDS 2017 annual data report: US Renal Data System; 2017 [Internet]. Available from: (Available from: https://www.usrds.org/2017/view/Default.aspx.)
5. Mirzapoor AZ, Hamedi AD, Rahmani B, Shahbadori R, Karami S, Peymani A, Taghizadeh S, Samiee RF. KRAS, NRAS, BRAF, and PIK3CA mutation rates, clinicopathological association, and their prognostic value in Iranian colorectal cancer patients. J Clin Lab Anal 2023; 37(5):e24868.
6. Stanton BA. Renal potassium transport: morphological and functional adaptations. Am J Physiol 1989; 257(5 Pt 2):R989-97.
7. Momoniat T, Ilyas D, Bhandari S. ACE inhibitors and ARBs: Managing potassium and renal function. Cleve Clin J Med 2019; 86(9):601-7.
8. Zillich AJ, Garg J, Basu S, Bakris GL, Carter BL. Thiazide diuretics, potassium, and the development of diabetes: a quantitative review. Hypertension 2006; 48(2):219-24.
9. Hayes J, Kalantar ZK, Lu JL, Turban S, Anderson JE, Kovesdy CP. Association of hypo- and hyperkalemia with disease progression and mortality in males with chronic kidney disease: the role of race. Nephron Clin Pract 2012; 120(1):c8-16.
10. Einhorn LM, Zhan M, Hsu VD, Walker LD, Moen MF, Seliger SL, Weir MR, Fink JC. The frequency of hyperkalemia and its significance in chronic kidney disease. Arch Intern Med 2009; 169(12):1156-62.
11. Korgaonkar S, Tilea A, Gillespie BW, Kiser M, Eisele G, Finkelstein F, Kotanko P, Pitt B, Saran R. Serum potassium and outcomes in CKD: insights from the RRI-CKD cohort study. Clin J Am Soc Nephrol 2010; 5(5):762-9.
12. Nakhoul GN, Huang H, Arrigain S, Jolly SE, Schold JD, Nally JV, Navaneethan SD. Serum Potassium, End-Stage Renal Disease and Mortality in Chronic Kidney Disease. Am J Nephrol 2015; 41(6):456-63.
13. Luo J, Brunelli SM, Jensen DE, Yang A. Association between Serum Potassium and Outcomes in Patients with Reduced Kidney Function. Clin J Am Soc Nephrol 2016; 11(1):90-100.
14. Xie P, Huang JM, Lin HY, Wu WJ, Pan LP. CDK-EPI equation may be the most proper formula based on creatinine in determining glomerular filtration rate in Chinese patients with chronic kidney disease. Int Urol Nephrol 2013; 45(4):1057-64.
15. Schlüter K, Cadamuro J. Erroneous potassium results: preanalytical causes, detection, and corrective actions. Crit Rev Clin Lab Sci 2023; 60(6):442-65.
16. Perez GO, Oster JR, Vaamonde CA. Serum potassium concentration in acidemic states. Nephron 1981; 27(4-5):233-43.
17. Palmer BF. Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med 2004; 351(6):585-92.
18. Unruh ML, Evans IV, Fink NE, Powe NR, Meyer KB. Skipped treatments, markers of nutritional nonadherence, and survival among incident hemodialysis patients. Am J Kidney Dis 2005; 46(6):1107-16.
19. Lowrie EG, Lew NL. Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990; 15(5):458-82.
20. Takaichi K, Takemoto F, Ubara Y, Mori Y. The clinically significant estimated glomerular filtration rate for hyperkalemia. Intern Med 2008; 47(14):1315-23.
21. Hsieh MF, Wu IW, Lee CC, Wang SY, Wu MS. Higher serum potassium level associated with late stage chronic kidney disease. Chang Gung Med J 2011; 34(4):418-25.
22. Gennari FJ, Segal AS. Hyperkalemia: An adaptive response in chronic renal insufficiency. Kidney Int 2002; 62(1):1-9.
23. Tanaka K, Saito H, Iwasaki T, Oda A, Watanabe S, Kanno M, Kimura H, Shimabukuro M, Asahi K, Watanabe T, Kazama JJ.Association between serum potassium levels and adverse outcomes in chronic kidney disease: the Fukushima CKD cohort study. Clin Exp Nephrol 2021; 25(4):410-7.
24. Molin CZD, Trevisol DJ. Persistent severe hypokalemia: Gitelman syndrome and differential diagnosis. J Bras Nefrol 2017; 39(3):337-40.
25. Yang J, Zhang X, Yu X, Tang W, Gan H. Renin-angiotensin system activation accelerates atherosclerosis in experimental renal failure by promoting endoplasmic reticulum stress-related inflammation. Int J Mol Med 2017; 39(3):613-21.
26. de Rooij ENM, de Fijter JW, Le Cessie S, Hoorn EJ, Jager KJ, Chesnaye NC, Evans M, Windahl K, Caskey FJ, Torino C, Szymczak M, Drechsler C, Wanner C, Dekker FW, Hoogeveen EK. Serum Potassium and Risk of Death or Kidney Replacement Therapy in Older People With CKD Stages 4-5: Eight-Year Follow-up. Am J Kidney Dis 2023; 82(3):257-66.e1.
27. Kovesdy CP, Matsushita K, Sang Y, Brunskill NJ, Carrero JJ, Chodick G, Hasegawa T, Heerspink HL, Hirayama A, Landman GWD, Levin A, Nitsch D, Wheeler DC, Coresh J, Hallan SI, Shalev V, Grams ME. Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis. Eur Heart J 2018; 39(17):1535-42.
28. de Zeeuw D, Akizawa T, Audhya P, Bakris GL, Chin M, Christ SH, Goldsberry A, Houser M, Krauth M, Lambers HJ, McMurray JJ, Meyer CJ, Parving HH, Remuzzi G, Toto RD, Vaziri ND, Wanner C, Wittes J, Wrolstad D, Chertow GM. Bardoxolone methyl in type 2 diabetes and stage 4 chronic kidney disease. N Engl J Med 2013; 369(26):2492-503.
29. Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, Wanner C, Krane V, Cass A, Craig J, Neal B, Jiang L, Hooi LS, Levin A, Agodoa L, Gaziano M, Kasiske B, Walker R, Massy ZA, Feldt RB, Krairittichai U, Ophascharoensuk V, Fellström B, Holdaas H, Tesar V, Wiecek A, Grobbee D, de Zeeuw D, Grönhagen RC, Dasgupta T, Lewis D, Herrington W, Mafham M, Majoni W, Wallendszus K, Grimm R, Pedersen T, Tobert J, Armitage J, Baxter A, Bray C, Chen Y, Chen Z, Hill M, Knott C, Parish S, Simpson D, Sleight P, Young A, Collins R. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 2011; 377(9784):2181-92.
30. Ohno S, Ishii A, Yanagita M, Yokoi H. Calcium channel blocker in patients with chronic kidney disease. Clin Exp Nephrol 2022; 26(3):207-15.
31. Thomsen RW, Nicolaisen SK, Hasvold P, Sanchez RG, Pedersen L, Adelborg K, Egstrup K, Egfjord M, Sørensen HT. Elevated potassium levels in patients with chronic kidney disease: occurrence, risk factors and clinical outcomes-a Danish population-based cohort study. Nephrol Dial Transplant 2018; 33(9):1610-20.
32. Kovesdy CP. Management of Hyperkalemia: An Update for the Internist. Am J Med 2015; 128(12):1281-7.
33. Seliger SL. Hyperkalemia in patients with chronic renal failure. Nephrol Dial Transplant 2019; 34(Suppl 3):iii12-iii8.
34. Kim DW, Song SH. Sarcopenia in chronic kidney disease: from bench to bedside. Korean J Intern Med 2023; 38(3):303-21.

Toplam 34 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Nefroloji
Bölüm	Araştırma Makalesi
Yazarlar	İvo Gökmen 0000-0002-0382-5396 Ömer Celal Elçioğlu 0000-0001-5943-0302
Erken Görünüm Tarihi	22 Mayıs 2025
Yayımlanma Tarihi	28 Mayıs 2025
Gönderilme Tarihi	14 Mayıs 2024
Kabul Tarihi	28 Ekim 2024
Yayımlandığı Sayı	Yıl 2025 Cilt: 11 Sayı: 2

Kaynak Göster

Vancouver	Gökmen İ, Elçioğlu ÖC. The Effect of Different Serum Potassium Levels on Progression of Chronic Kidney Disease. Akd Tıp D. 2025;11(2):266-7.

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