Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep;38(9):3083-3090.
doi: 10.1007/s00467-023-05912-2. Epub 2023 Mar 20.

Hyperkalemia in pediatric chronic kidney disease

Katherine L Kurzinski  1 , Yunwen Xu  2 , Derek K Ng  2 , Susan L Furth  3 , George J Schwartz  4 , Bradley A Warady  5 ; CKiD Study Investigators
Affiliations

Hyperkalemia in pediatric chronic kidney disease

Katherine L Kurzinski et al. Pediatr Nephrol. 2023 Sep.

Abstract

Background: While hyperkalemia is well described in adult chronic kidney disease (CKD), large studies evaluating potassium trends and risk factors for hyperkalemia in pediatric CKD are lacking. This study aimed to characterize hyperkalemia prevalence and risk factors in pediatric CKD.

Methods: Cross-sectional analysis of Chronic Kidney Disease in Children (CKiD) study data evaluated median potassium levels and percentage of visits with hyperkalemia (K ≥5.5 mmoL/L) in relation to demographics, CKD stage, etiology, proteinuria, and acid-base status. Multiple logistic regression was used to identify risk factors for hyperkalemia.

Results: One thousand and fifty CKiD participants with 5183 visits were included (mean age 13.1 years, 62.7% male, 32.9% self-identifying as African American or Hispanic). A percentage of 76.6% had non-glomerular disease, 18.7% had CKD stage 4/5, 25.8% had low CO2, and 54.2% were receiving ACEi/ARB therapy. Unadjusted analysis identified a median serum potassium level of 4.5 mmol/L (IQR 4.1-5.0, p <0.001) and hyperkalemia in 6.6% of participants with CKD stage 4/5. Hyperkalemia was present in 14.3% of visits with CKD stage 4/5 and glomerular disease. Hyperkalemia was associated with low CO2 (OR 7.72, 95%CI 3.05-19.54), CKD stage 4/5 (OR 9.17, 95%CI 4.02-20.89), and use of ACEi/ARB therapy (OR 2.14, 95%CI 1.36-3.37). Those with non-glomerular disease were less frequently hyperkalemic (OR 0.52, 95%CI 0.34-0.80). Age, sex, and race/ethnicity were not associated with hyperkalemia.

Conclusions: Hyperkalemia was observed more frequently in children with advanced stage CKD, glomerular disease, low CO2, and ACEi/ARB use. These data can help clinicians identify high-risk patients who may benefit from earlier initiation of potassium-lowering therapies. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Hyperkalemia; Pediatric chronic kidney disease.

PubMed Disclaimer

References

    1. Valdivielso JM, Balafa O, Ekart R, Ferro C, et al. Hyperkalemia in Chronic Kidney Disease in the New Era of Kidney Protection Therapies. Drugs. 2021;81(13):1467–1489. doi:10.1007/s40265-021-01555-5 - DOI - PubMed
    1. Whittaker CF, Miklich MA, Patel RS, Fink JC. Medication Safety Principles and Practice in CKD. Clin J Am Soc Nephrol. 2018;13(11):1738–1746. doi:10.2215/CJN.00580118 - DOI - PMC - PubMed
    1. Gilligan S, Raphael KL. Hyperkalemia and Hypokalemia in CKD: Prevalence, Risk Factors, and Clinical Outcomes. Adv Chronic Kidney Dis. 2017;24(5):315–318. doi:10.1053/j.ackd.2017.06.004 - DOI - PubMed
    1. Luo J, Brunelli SM, Jensen DE, Yang A. Association between Serum Potassium and Outcomes in Patients with Reduced Kidney Function. Clin J Am Soc Nephrol. 2016;11(1):90–100. doi:10.2215/CJN.01730215 - DOI - PMC - PubMed
    1. Nakhoul GN, Huang H, Arrigain S, Jolly S, et al. Serum Potassium, End-Stage Renal Disease and Mortality in Chronic Kidney Disease. Am J Nephrol. 2015;41(6):456–463. doi:10.1159/000437151 - DOI - PMC - PubMed

Publication types

Substances