Presenter Status

Fellow

Abstract Type

Research

Primary Mentor

Bradley Warady

Start Date

6-5-2022 12:30 PM

End Date

6-5-2022 12:45 PM

Presentation Type

Oral Presentation

Description

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Background: Potassium trends are well described in adult chronic kidney disease (CKD) and hyperkalemia is known to be associated with increased disease progression, morbidity, and mortality. Large scale studies assessing potassium trends and the prevalence of hyperkalemia in pediatric CKD have not been performed.

Objectives/Goal: We aimed to characterize median serum potassium levels and the prevalence of hyperkalemia for each CKD stage using the CKiD cohort. The relationship of serum potassium and hyperkalemia with patient demographics, CKD etiology (glomerular or non-glomerular), presence of acidosis, and degree of proteinuria was also evaluated.

Methods/Design: Median serum potassium levels and the percentage of laboratory assessments in which hyperkalemia (K > 5.5mmol/L) was detected were compared across CKD stages as estimated by 2009 Bedside Schwartz or 2012 Cystatin C-Creatinine CKiD equations. The Kruskal-Wallis test was used to compare median potassium levels across groups including sex, ethnicity, CKD etiology, presence of acidosis, and degree of proteinuria. Chi square tests were used to compare the percentage of assessments with hyperkalemia across the above groups.

Results: Laboratory data from 5044 study visits with 1038 patients were included. ACE inhibitor/ARB and diuretic usage was more common in patients with glomerular (79.2% and 46.6%) vs nonglomerular (11.5% and 4.0%) CKD (p < 0.001 for both). Median serum potassium levels and the percentage of assessments with hyperkalemia significantly increased with advancing CKD stage for patients with glomerular and nonglomerular CKD (Table 1). Acidosis (CO2<22mmol/L) and nephrotic-range proteinuria (UPCR >2.0) were also associated with higher median serum potassium levels and a significantly greater frequency of hyperkalemia when compared to assessments without acidosis or nephrotic-range proteinuria (Table 2). Whereas there was no difference in the percentage of study visits in which hyperkalemia was detected between females and males (2.1% versus 2.3%, p=0.730), hyperkalemia was significantly more common in Hispanic patients (3.6% versus 2.0% non-Hispanic, p=0.011).

Conclusions: Within the CKiD cohort, patients with more advanced stages of CKD, acidosis, and nephrotic-range proteinuria had significantly higher median serum potassium levels and a higher percentage of laboratory assessments with hyperkalemia, irrespective of CKD etiology. This information can help identify those patients at greatest risk for substantial elevations of serum potassium who may benefit from dietary and/or medication interventions.

MeSH Keywords

Chronic Kidney Disease; Pediatrics; Potassium

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May 6th, 12:30 PM May 6th, 12:45 PM

Potassium Status in Pediatric Chronic Kidney Disease

Watch recording of live presentation.

Background: Potassium trends are well described in adult chronic kidney disease (CKD) and hyperkalemia is known to be associated with increased disease progression, morbidity, and mortality. Large scale studies assessing potassium trends and the prevalence of hyperkalemia in pediatric CKD have not been performed.

Objectives/Goal: We aimed to characterize median serum potassium levels and the prevalence of hyperkalemia for each CKD stage using the CKiD cohort. The relationship of serum potassium and hyperkalemia with patient demographics, CKD etiology (glomerular or non-glomerular), presence of acidosis, and degree of proteinuria was also evaluated.

Methods/Design: Median serum potassium levels and the percentage of laboratory assessments in which hyperkalemia (K > 5.5mmol/L) was detected were compared across CKD stages as estimated by 2009 Bedside Schwartz or 2012 Cystatin C-Creatinine CKiD equations. The Kruskal-Wallis test was used to compare median potassium levels across groups including sex, ethnicity, CKD etiology, presence of acidosis, and degree of proteinuria. Chi square tests were used to compare the percentage of assessments with hyperkalemia across the above groups.

Results: Laboratory data from 5044 study visits with 1038 patients were included. ACE inhibitor/ARB and diuretic usage was more common in patients with glomerular (79.2% and 46.6%) vs nonglomerular (11.5% and 4.0%) CKD (p < 0.001 for both). Median serum potassium levels and the percentage of assessments with hyperkalemia significantly increased with advancing CKD stage for patients with glomerular and nonglomerular CKD (Table 1). Acidosis (CO2<22mmol/L) and nephrotic-range proteinuria (UPCR >2.0) were also associated with higher median serum potassium levels and a significantly greater frequency of hyperkalemia when compared to assessments without acidosis or nephrotic-range proteinuria (Table 2). Whereas there was no difference in the percentage of study visits in which hyperkalemia was detected between females and males (2.1% versus 2.3%, p=0.730), hyperkalemia was significantly more common in Hispanic patients (3.6% versus 2.0% non-Hispanic, p=0.011).

Conclusions: Within the CKiD cohort, patients with more advanced stages of CKD, acidosis, and nephrotic-range proteinuria had significantly higher median serum potassium levels and a higher percentage of laboratory assessments with hyperkalemia, irrespective of CKD etiology. This information can help identify those patients at greatest risk for substantial elevations of serum potassium who may benefit from dietary and/or medication interventions.

 

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