WASHINGTON—Hyperkalemia in patients with chronic kidney disease (CKD) stage 3 or 4 is associated with an increased likelihood of progression to CKD stage 5, according to study findings presented at the American Society of Nephrology’s 2019 Kidney Week conference.

In a study of 45,984 adult patients with CKD stage 3 or 4 (9220 with and 36,764 without hyperkalemia), 16.7% of patients with hyperkalemia progressed to CKD stage 5 over the 5-year study period compared with 3.5% of those without hyperkalemia, Fan Wu, PhD, MS, of Analysis Group Inc., Boston, and colleagues reported in a poster presentation.

In addition, a higher proportion of patients with vs without hyperkalemia experienced a 10-unit or greater decline in estimated glomerular filtration rate (eGFR) during the study period (31.7% vs 17%).

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The presence of hyperkalemia, compared with its absence, was significantly associated with a 2.2- and 2.4-fold increased risk of progression to CKD stage 5 or end-stage renal disease and a 10-unit or greater decline in eGFR, respectively, in adjusted analyses.

Dr Chamberlain and her collaborators identified their study population using electronic medical records from the US Research Action for Health Network. They defined hyperkalemia as 1 or more serum potassium values above 5.0 mEq/L and confirmed by another hyperkalemia event.

The new findings are consistent with those of a study of patients with nondialysis CKD published in the Journal of Clinical Medicine in 2018. In that study, patients with new-onset or persistent hyperkalemia had significant 34% and 27% higher risks for end-stage renal disease, respectively, compared with patients who did not have hyperkalemia.


Mu F, Davis J, Israni R, et al. Hyperkalemia and progression of CKD. Presented at the American Society of Nephrology’s 2019 Kidney Week conference held in Washington, DC, from November 5-10. Poster FR-PO654.