Hyperkalemia is associated with decline in residual kidney function in the first year of hemodialysis (HD), investigators reported in a poster presentation at the American Society of Nephrology’s Kidney Week 2021.

In a study of 6655 patients, renal urea clearance (KRU) declined by a median of 1.24 from the first to fifth patient quarter after HD initiation, Elani Streja, MPH, PhD, of the University of California Irvine, reported on behalf of her team. Median KRU slope also declined by 1.64 over the period.

Compared with normal-range potassium, serum potassium levels exceeding 4.5 mEq/L were associated with the greatest declines in KRU in the first year: -0.28 in a case-mix model and -0.20 in a model additionally adjusted for malnutrition-inflammation complex syndrome (MICS), Dr Streja reported. The same pattern was observed using KRU slope.

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According to a mediation analysis, decline in KRU slope accounted for only 1.78% of the relationship between serum potassium and mortality.

“Hyperkalemia shows associations with renal decline over the first year on HD. However, the renal function decline only minimally mediates the relationship between potassium and death after the first year of HD,” Dr Streja’s team stated. “Future studies should be conducted to investigate the pathways underlying these associations.”


Edward JA, Wenziger C, Hsiung J-T, et al. Association of potassium with decline in residual kidney function in incident hemodialysis patients. Presented at: Kidney Week 2021, November 2-7, 2021. Poster PO2380.