Both transient and chronic hyperkalemia in patients with nondialysis-dependent chronic kidney disease (CKD) are associated with major adverse cardiovascular events (MACE) and death, according to new study findings.

Among 36,511 adults with stage 3 to 5 CKD, transient and chronic hyperkalemia, respectively, were observed in 15% and 4% of patients with stage G3a, 23% and 7% of patients with stage 3b, 36% and 11% of patients with stage 4, and 50% and 17% of patients with stage 5 CKD, Marco Trevisan, PhD candidate at Karolinska Institutet in Stockholm, Sweden, and colleagues reported in Clinical Kidney Journal. Transient hyperkalemia was defined as serum potassium levels exceeding 5.0 mmol/L for 6 months or less over the previous year. Hyperkalemia persisting for more than 6 months was considered chronic hyperkalemia.

Along with decreasing estimated glomerular filtration rate, male sex, diabetes, and vascular disease were possible risk factors for both transient and chronic hyperkalemia, analyses showed. Use of renin-angiotensin-aldosterone system inhibitors was also linked with hyperkalemia.

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Compared with normokalemia, transient and chronic hyperkalemia patterns were significantly associated with 36% and 16% increased odds of MACE, respectively. When factored into their analyses, the investigators found that current hyperkalemia showed no relationship with MACE. MACE was defined as nonfatal stroke, heart failure, myocardial infarction or death attributed to cardiovascular causes. The study lacked electrocardiography data, so serum potassium values could not be assessed alongside cardiac rhythm disturbances.

In a fully adjusted model, transient hyperkalemia was significantly associated with 43% increased odds for death. Both high and low current serum potassium values predicted elevated risks for death. Chronic hyperkalemia showed no relationship with death from noncardiovascular causes in a combined model.

According to the investigators, the transient and chronic hyperkalemia patterns offered additional predictive value beyond current serum potassium value, but imperfectly.

“As a clinical application, because any potassium abnormality here modelled predicted worse outcomes, our results support the value of potassium monitoring and evaluation of potassium trends in clinical practice,” Trevisan’s team wrote. “However, they are also consistent with the idea that dyskalaemias are a biomarker of underlying illness or physiologic disturbance, rather than a causal risk factor.”

Disclosure: This research was supported by Vifor Pharma. Please see the original reference for a full list of disclosures.


Trevisan M, Clase CM, Evans M, et al. Patterns of chronic and transient hyperkalemia and clinically-important outcomes in patients with chronic kidney disease. Clin Kidney J. Published online September 4, 2021. doi:10.1093/ckj/sfab159