Hyperkalemia in Chronic Kidney Disease Patients under Conservative Treatment

Background: Hyperkalemia is one of such disturbances that have a great concern in CKD patients for its possible potential for associated adverse cardiac outcomes. The principal causes of hyperkalemia in CKD patient include an impaired glomerular filtration rate (GFR) combined with a frequently high dietary potassium intake relative to residual renal function, a commonly observed extracellular shift of potassium caused by the metabolic acidosis of renal failure and, most importantly, recommended treatment with renin angiotensin aldosterone system (RAAS) blockers that inhibit renal potassium excretion. The aim of this study is to examine the prevalence and potential determinants of hyperkalemia in a population of predialysis CKD patients under conservative therapy. Patients and Methods: This is a 4 month cross-sectional study in predialysis CKD patients under regular follow-up in the LCC. 78 patients are recruited for the study. Information of serum potassium and different other laboratory variables, Co-morbidities, and the using medications are recorded for each participant. In univariate analysis, clinical and laboratory parameters were compared for patients to identify factors associated with hyperkalemia (potassium >5.5 meq/L).Results: From total 74 patients recruited for the study, 14 (17.9%) of them had serum potassium level > 5.5 meq/l. They are older than patients without hyperkalemia but with no statistical difference. Also, they are more obese, more hypertensive but with no statistical differences. There was no statistical significant difference between male and female patients and no statistically significant effect of causes of CKD and comorbitidies on hyperkaemia. Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was not associated with hyperkalemia. The GFR was lower in hyperkalemic patients, but with no statistically significant difference, however, the bicarbonate level was lower in hyperkalemic patients with highly statistical difference to patients without hyperkalemia p 0.015.Conclusion:Hyperkalemia is common in stable predialysis CKD patients. The most important risk factors are low GFR, low serum bicarbonate level. Using of ACEi or ARBs is not associated with high risk hyperkalemia.