Diabetes mellitus is associated with a significantly increased prevalence of hyperkalemia among patients with stage 3 chronic kidney disease (CKD), a new study found.

The study, published online ahead of print in the American Journal of Nephrology, also found that stage 4 CKD and ACE inhibitor use are major determinants of hyperkalemia occurrence in multivariate analysis.

Charalampos Loutradis, MD, of Aristotle University of Thessaloniki in Greece, and colleagues conducted a nested case-control study of 180 type 2 diabetic and 180 non-diabetic patients with CKD. The prevalence of hyperkalemia—defined as a serum potassium level above 5 mEq/L—was higher in the diabetic than non-diabetic patients (27.2% vs. 20%), but the difference was not statistically significant. Among patients with stage 3 CKD, the difference in hyperkalemia prevalence between diabetic and non-diabetic patients was statistically significant (28.6% vs. 17.5%). The researchers observed no statistically significant difference in hyperkalemia prevalence among patients with stages 2 and 4 CKD.

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Stage 4 CKD and use of ACE inhibitors were associated with 4.5-fold and 2.2-fold increased odds of hyperkalemia, respectively.

As the vast majority of patients with CKD have stage 3 disease, the authors concluded, the presence of diabetes in these patients must be appreciated with respect to hyperkalemia risk and relevant therapeutic decisions.