archives@tulane.edu / Background: Chronic kidney disease (CKD) is a disease that affects 13.6% of American adults. The prevalence of abnormal serum potassium levels and their downstream renal and cardiovascular effects in CKD are not clearly understood.
Objective: The objective of this project is to determine the prevalence of abnormal serum potassium in the CKD population in the United States and to identify associations between abnormal serum potassium and renal and cardiovascular endpoints in CKD patients.
Paper 1: At baseline, 4.07% of CRIC study participants had hypokalemia and 7.65% had hyperkalemia. Non-Hispanic Black participants had the highest prevalence of hypokalemia (5.67%), and Hispanic CKD patients had the highest prevalence of hyperkalemia (10.92%). Women, non-Hispanic Black individuals, and individuals who were non-diabetic and/or middle-aged at baseline were likelier to experience hypokalemia at some point during the CRIC study. Male gender, Hispanic ethnicity, diabetes at baseline, higher CKD stage at baseline, and younger age at baseline were found to be risk factors for ever experiencing hyperkalemia. Overall, over 40% of participants experienced an abnormal serum potassium level at some point during the study.
Paper 2: Using time-updated serum potassium, hypokalemia was associated with increased risk of ESRD. Hyperkalemia was associated with increased risk of both ESRD and CKD progression. Baseline-only modeling of hypokalemia and hyperkalemia as exposures did not identify significant associations with renal outcomes.
Paper 3: Using baseline-only serum potassium, hypokalemia was associated with both all-cause mortality [HR = 1.31; 95% CI: (1.01, 1.71)] and cardiovascular disease [HR = 1.49; 95% CI: (1.18, 1.89)]. However, marginal structural models with repeated potassium measures only identified elevated risk of cardiovascular disease associated with hypokalemia [HR = 1.36; 95% CI: (1.18, 1.89)].
Conclusion: The results of this project demonstrate that abnormal serum potassium is a prevalent problem in the United States CKD population. Very low and very high potassium levels are associated with severe renal and cardiovascular outcomes, and these associations are stronger in some subgroups compared to others, including older and Hispanic CKD patients. This information can help clinicians identify individuals at high risk for severe endpoints and intervene early to prevent these outcomes from occurring. Future research should focus on establishing causality, which could provide a new treatment target for preventing renal and cardiovascular outcomes in CKD patients. / 1 / Andrei Stefanescu
| Identifer | oai:union.ndltd.org:TULANE/oai:http://digitallibrary.tulane.edu/:tulane_121966 |
| Date | January 2021 |
| Contributors | Stefanescu, Andrei (author), Mills, Katherine (Thesis advisor), He, Jiang (Thesis advisor), Chen, Jing (Thesis advisor), Anderson, Amanda (Thesis advisor), School of Public Health & Tropical Medicine Epidemiology (Degree granting institution) |
| Publisher | Tulane University |
| Source Sets | Tulane University |
| Language | English |
| Detected Language | English |
| Type | Text |
| Format | electronic, pages: 157 |
| Rights | No embargo, Copyright is in accordance with U.S. Copyright law. |
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