Investigators have created a nomogram that predicts the risk of hyperkalemia within 6 months in patients with stage 3 or higher chronic kidney disease (CKD) who are not on dialysis.

Patients identified as “high risk” using the hyperkalemia nomogram may benefit from intensive monitoring and early triage, according to Cheng Xue, MD, of Changzheng Hospital, China, and colleagues.

In a training set of 847 patients with stage 3 or higher CKD, 27.6% experienced hyperkalemia (serum potassium 5.5 mmol/L or higher) within 6 months. The investigators identified age 75 years or older, higher CKD stages, previous episode of serum potassium 5.0 mmol/L or higher within 3 months, heart failure, diabetes, and metabolic acidosis as independent risk factors.

Continue Reading

Dr Xue and his team developed a nomogram based on these risk factors and the use of renin-angiotensin-aldosterone system (RAAS) inhibitors. Using the nomogram was better than treating all patients with CKD assuming they had hyperkalemia. The C-statistic of the model was 0.757 in the training set, 0.732 in an internal validation set, and 0.878 and 0.817 in external validation sets, the investigators reported in Kidney360.

Dr Xue’s team pointed out that electrolyte monitoring in routine clinical practice is suboptimal in patients whether or not they are initiating treatment with RAAS inhibitors.

“Although potassium binders for hyperkalemia treatment are effective and available, the early warning of hyperkalemia is still challenging, for patients are often asymptomatic, and blood potassium monitoring is underperformed.”

The investigators describe their hyperkalemia nomogram as less complicated and more feasible compared with other recently developed tools for the CKD population. Due to small sample sizes, the nomogram still needs to be further validated. The nomogram is not suitable for patients with an eGFR more than 60 mL/min/m2.


Xue C, Zhou C, Yang B, et al. A nomogram to identify hyperkalemia risk in patients with advanced chronic kidney disease. Kidney360 September 2022. doi:10.34067/KID.0004752022