Hyung Woo Kim1, Jung Tak Park1, Tae-Hyun Yoo1, Joongyub Lee2, Wookyung Chung3, Kyu-Beck Lee4, Dong-Wan Chae5, Curie Ahn5, Shin-Wook Kang1, Kyu Hun Choi1, Seung Hyeok Han6. 1. Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea. 2. Department of Prevention and Management, School of Medicine, Inha University, Incheon, Korea. 3. Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Korea. 4. Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; and. 5. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. 6. Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Korea; hansh@yuhs.ac.
Abstract
BACKGROUND AND OBJECTIVES: Data on whether low or high urinary potassium excretion is associated with poor kidney outcome have been conflicting. The aim of this study was to clarify the association between urinary potassium excretion and CKD progression. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We investigated the relationship between lower urinary potassium excretion and CKD progression and compared three urinary potassium indices among 1821 patients from the Korean Cohort Study for Outcome in Patients with CKD. Urinary potassium excretion was determined using spot urinary potassium-to-creatinine ratio, spot urinary potassium concentration, and 24-hour urinary potassium excretion. Patients were categorized into four groups according to quartiles of each urinary potassium excretion metric. The study end point was a composite of a ≥50% decrease in eGFR from baseline values and ESKD. RESULTS: During 5326 person-years of follow-up, the primary outcome occurred in 392 (22%) patients. In a multivariable cause-specific hazard model, lower urinary potassium-to-creatinine ratio was associated with higher risk of CKD progression (adjusted hazard ratio, 1.47; 95% confidence interval, 1.01 to 2.12) comparing the lowest quartile with the highest quartile. Sensitivity analyses with other potassium metrics also showed consistent results in 855 patients who completed 24-hour urinary collections: adjusted hazard ratios comparing the lowest quartile with the highest quartile were 3.05 (95% confidence interval, 1.54 to 6.04) for 24-hour urinary potassium excretion, 1.95 (95% confidence interval, 1.05 to 3.62) for spot urinary potassium-to-creatinine ratio, and 3.79 (95% confidence interval, 1.51 to 9.51) for spot urinary potassium concentration. CONCLUSIONS: Low urinary potassium excretion is associated with progression of CKD.
BACKGROUND AND OBJECTIVES: Data on whether low or high urinary potassium excretion is associated with poor kidney outcome have been conflicting. The aim of this study was to clarify the association between urinary potassium excretion and CKD progression. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We investigated the relationship between lower urinary potassium excretion and CKD progression and compared three urinary potassium indices among 1821 patients from the Korean Cohort Study for Outcome in Patients with CKD. Urinary potassium excretion was determined using spot urinary potassium-to-creatinine ratio, spot urinary potassium concentration, and 24-hour urinary potassium excretion. Patients were categorized into four groups according to quartiles of each urinary potassium excretion metric. The study end point was a composite of a ≥50% decrease in eGFR from baseline values and ESKD. RESULTS: During 5326 person-years of follow-up, the primary outcome occurred in 392 (22%) patients. In a multivariable cause-specific hazard model, lower urinary potassium-to-creatinine ratio was associated with higher risk of CKD progression (adjusted hazard ratio, 1.47; 95% confidence interval, 1.01 to 2.12) comparing the lowest quartile with the highest quartile. Sensitivity analyses with other potassium metrics also showed consistent results in 855 patients who completed 24-hour urinary collections: adjusted hazard ratios comparing the lowest quartile with the highest quartile were 3.05 (95% confidence interval, 1.54 to 6.04) for 24-hour urinary potassium excretion, 1.95 (95% confidence interval, 1.05 to 3.62) for spot urinary potassium-to-creatinine ratio, and 3.79 (95% confidence interval, 1.51 to 9.51) for spot urinary potassium concentration. CONCLUSIONS: Low urinary potassium excretion is associated with progression of CKD.
Authors: Andrew Mente; Martin J O'Donnell; Gilles Dagenais; Andy Wielgosz; Scott A Lear; Matt J McQueen; Ying Jiang; Wang Xingyu; Bo Jian; K Burco T Calik; Ayse A Akalin; Prem Mony; Anitha Devanath; Afzal H Yusufali; Patricio Lopez-Jaramillo; Alvaro Avezum; Khaled Yusoff; Annika Rosengren; Lanthe Kruger; Andrés Orlandini; Sumathi Rangarajan; Koon Teo; Salim Yusuf Journal: J Hypertens Date: 2014-05 Impact factor: 4.844
Authors: Jiang He; Katherine T Mills; Lawrence J Appel; Wei Yang; Jing Chen; Belinda T Lee; Sylvia E Rosas; Anna Porter; Gail Makos; Matthew R Weir; L Lee Hamm; John W Kusek Journal: J Am Soc Nephrol Date: 2015-09-17 Impact factor: 10.121
Authors: David R Jacobs; Myron D Gross; Lyn Steffen; Michael W Steffes; Xinhua Yu; Laura P Svetkey; Lawrence J Appel; William M Vollmer; George A Bray; Thomas Moore; Paul R Conlin; Frank Sacks Journal: Am J Kidney Dis Date: 2009-01-23 Impact factor: 8.860
Authors: Lesley A Inker; Brad C Astor; Chester H Fox; Tamara Isakova; James P Lash; Carmen A Peralta; Manjula Kurella Tamura; Harold I Feldman Journal: Am J Kidney Dis Date: 2014-03-16 Impact factor: 8.860
Authors: Martin Gritter; Rosa D Wouda; Stanley M H Yeung; Michiel L A Wieërs; Frank Geurts; Maria A J de Ridder; Christian R B Ramakers; Liffert Vogt; Martin H de Borst; Joris I Rotmans; Ewout J Hoorn Journal: J Am Soc Nephrol Date: 2022-05-24 Impact factor: 14.978
Authors: Curt D Sigmund; Robert M Carey; Lawrence J Appel; Donna K Arnett; Hayden B Bosworth; William C Cushman; Zorina S Galis; Melissa Green Parker; John E Hall; David G Harrison; Alicia A McDonough; Holly L Nicastro; Suzanne Oparil; John W Osborn; Mohan K Raizada; Jacqueline D Wright; Young S Oh Journal: Hypertension Date: 2020-02-17 Impact factor: 10.190
Authors: Mindy Pike; Thomas G Stewart; Jennifer Morse; Patrick Ormsby; Edward D Siew; Adriana Hung; Khaled Abdel-Kader; T Alp Ikizler; Loren Lipworth; Cassianne Robinson-Cohen Journal: Kidney Int Rep Date: 2019-04-04