Pre-Transplant Plasma Potassium as a Potential Risk Factor for the Need of Early Hyperkalaemia Treatment after Kidney Transplantation: A Cohort Study

Abstract

Introduction: Plasma potassium (K+) abnormalities are common among patients with chronic kidney disease and are associated with higher rates of death, major adverse cardiac events, and hospitalization in this population. Currently, no guidelines exist on how to handle pre-transplant plasma K+ in renal transplant recipients (RTR).

Objective: The aim of this study is to examine the relation between pre-transplant plasma K+ and interventions to resolve hyperkalaemia within 48 h after kidney transplantation.

Methods: In a single-centre cohort study, we addressed the association between the last available plasma K+ level before transplantation and the post-transplant need for dialysis or use of K+-lowering medication to resolve hyperkalaemia within 48 h after renal transplantation using multivariate logistic regression analysis.

Results: 151 RTR were included, of whom 51 (33.8%) patients received one or more K+ interventions within 48 h after transplantation. Multivariate regression analysis revealed that a higher pre-transplant plasma K+ was associated with an increased risk of post-transplant intervention (odds ratio 2.2 [95% CI: 1.1-4.4]), independent of donor type (deceased or living) and use of K+-lowering medication within 24 h prior to transplantation).

Conclusions: This study indicates that a higher pre-transplant plasma K+ is associated with a higher risk of interventions necessary to resolve hyperkalaemia within 48 h after renal transplantation. Further research is recommended to determine a cutoff level for pre-transplant plasma K+ that can be used in practice.

Keywords: Hyperkalaemia treatment; Kidney transplantation; Plasma potassium.

Fig. 1

Histogram and kernel-density plots of pre-transplant plasma potassium at the PACU (median = 4.4 [IQR = 3.9–4.9]) (a), plasma potassium at the PACU (median = 4.7 [IQR = 4.4–5.4]) (b), plasma potassium 24 h after transplantation (median = 4.6 [IQR = 4.1–5.1]) (c), and plasma potassium 48 h after transplantation (median = 4.3 [IQR = 3.9–4.7]) (d). PACU, post-anaesthesia care unit.