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Stenberg, J., Melin, J., Lindberg, M. & Furuland, H. (2019). Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients. Hemodialysis International, 23(3), 402-413
Open this publication in new window or tab >>Brain natriuretic peptide reflects individual variation in hydration status in hemodialysis patients
2019 (English)In: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 23, no 3, p. 402-413Article in journal (Refereed) Published
Abstract [en]

Introduction: Fluid management in hemodialysis patients is a controversial topic. Brain natriuretic peptide (BNP) is secreted from the heart in response to volume overload, and may be a marker of overhydration in hemodialysis patients. Our aim was to investigate the correlation between BNP and overhydration in a cohort of hemodialysis patients, and to find out whether BNP and overhydration correlate in repeated measurements within individuals with elevated BNP.

Methods: The study was prospective, observational, and had a cross-sectional part and a longitudinal follow-up. The distribution of BNP was investigated in a cohort of 64 hemodialysis patients. Blood samples and bioimpedance spectroscopy measurements were performed before midweek dialysis. Subsequently, 11 study participants with elevated BNP concentrations (>500 pg/mL) were assessed in another nine dialysis sessions each. These individuals also had their cardiac function and heart rate variability (HRV) examined.

Findings: BNP was above 500 pg/mL in 38% of the participants, and correlated positively with overhydration (r(s) = 0.381), inflammation and malnutrition, but not with systolic blood pressure. In comparison to participants with BNP below 500 pg/mL, participants with elevated BNP were older, had lower muscle strength, lower bodyweight and lower levels of hemoglobin and albumin. Echocardiography revealed cardiac anomalies in all 11 participants in the longitudinal follow-up, and HRV, as measured by SDNN, was pathologically low. In repeated measurements, the between-individuals variation of BNP in relation to overhydration was greater (SD = 0.581) than the within-person variation (SD = 0.285).

Discussion: BNP correlates positively to overhydration, malnutrition, and inflammation. In a subgroup of patients with elevated BNP, who are mainly elderly and frail, BNP reflects individual variation in hydration status, and hence seems to be a modifiable marker of overhydration. These data suggest that BNP is best applied for measuring changes in hydration status within an individual over time.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
Fluid overload, brain natriuretic peptide (BNP), bioimpedance, hemodialysis, repeated measurements
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-391030 (URN)10.1111/hdi.12751 (DOI)000475503700025 ()30848066 (PubMedID)
Available from: 2019-08-19 Created: 2019-08-19 Last updated: 2019-08-19Bibliographically approved
Linde, C., Bakhai, A., Furuland, H., Evans, M., McEwan, P., Ayoubkhani, D. & Qin, L. (2019). Real-World Associations of Renin-Angiotensin-Aldosterone System Inhibitor Dose, Hyperkalemia, and Adverse Clinical Outcomes in a Cohort of Patients With New-Onset Chronic Kidney Disease or Heart Failure in the United Kingdom. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 8(22), Article ID e012655.
Open this publication in new window or tab >>Real-World Associations of Renin-Angiotensin-Aldosterone System Inhibitor Dose, Hyperkalemia, and Adverse Clinical Outcomes in a Cohort of Patients With New-Onset Chronic Kidney Disease or Heart Failure in the United Kingdom
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2019 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 8, no 22, article id e012655Article in journal (Refereed) Published
Abstract [en]

Background-Dosing of renin-angiotensin-aldosterone system inhibitors (RAASi) may be modified to manage associated hyperkalemia risk; however, this approach could adversely affect cardiorenal outcomes. This study investigated real-world associations of RAASi dose, hyperkalemia, and adverse clinical outcomes in a large cohort of UK cardiorenal patients. Methods and Results-This observational study included RAASi-prescribed patients with new-onset chronic kidney disease (n=100 572) or heart failure (n=13 113) first recorded between January 2006 and December 2015 in Clinical Practice Research Datalink and linked Hospital Episode Statistics databases. Odds ratios associating hyperkalemia and RAASi dose modification were estimated using logistic generalized estimating equations with normal (<5.0 mmol/L) serum potassium level as the reference category. Patients with serum potassium >= 5.0 mmol/L had higher risk of RAASi down-titration (adjusted odds ratios, chronic kidney disease: 1.79 [95% CI, 1.64-1.96]; heart failure: 1.33 [95% CI, 1.08-1.62]). Poisson models were used to estimate adjusted incident rate ratios of adverse outcomes based on total RAASi exposure (<50% and >= 50% of the guideline-recommended RAASi dose). Incidence of major adverse cardiac events and mortality was consistently higher in the lower dose group (adjusted incident rate ratios: chronic kidney disease: 5.60 [95% CI, 5.29-5.93] for mortality and 1.60 [95% CI, 1.55-1.66] for nonfatal major adverse cardiac events; heart failure: 7.34 [95% CI, 6.35-8.48] for mortality and 1.85 [95% CI, 1.71-1.99] for major adverse cardiac events). Conclusions-The results of this real-world analysis highlight the potential negative impact of suboptimal RAASi dosing and the need for strategies that allow patients to be maintained on appropriate therapy, avoiding RAASi dose modification or discontinuation.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
chronic kidney disease, heart failure, hyperkalemia, major adverse cardiac event, renin-angiotensin system
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-398573 (URN)10.1161/JAHA.119.012655 (DOI)000496997400005 ()31711387 (PubMedID)
Funder
AstraZeneca
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-09Bibliographically approved
Linde, C., Qin, L., Bakhai, A., Furuland, H., Evans, M., Ayoubkhani, D., . . . McEwan, P. (2019). Serum potassium and clinical outcomes in heart failure patients: results of risk calculations in 21 334 patients in the UK. ESC Heart Failure, 6(2), 280-290
Open this publication in new window or tab >>Serum potassium and clinical outcomes in heart failure patients: results of risk calculations in 21 334 patients in the UK
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2019 (English)In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 6, no 2, p. 280-290Article in journal (Refereed) Published
Abstract [en]

Aims: At present, the clinical burden of hypokalaemia and hyperkalaemia among European heart failure patients, and relationships between serum potassium and adverse clinical outcomes in this population, is not well characterized. The aim of this study was to investigate associations between mortality, major adverse cardiac events, and renin–angiotensin–aldosterone system inhibitor (RAASi) discontinuation across serum potassium levels, in a UK cohort of incident heart failure patients.

Methods and results: This was a retrospective observational cohort study of newly diagnosed heart failure patients listed in the Clinical Practice Research Datalink, with a first record of heart failure (index date) between 2006 and 2015. Hypokalaemia and hyperkalaemia episodes were defined as the number of serum potassium measurements exceeding each threshold (<3.5, ≥5.0, ≥5.5, and ≥6.0 mmol/L), without such a measurement in the preceding 7 days. Risk equations developed using Poisson generalized estimating equations were utilized to estimate adjusted incident rate ratios (IRRs) relating serum potassium and clinical outcomes (death, major adverse cardiac event, and RAASi discontinuation). Among 21,334 eligible heart failure patients, 1969 (9.2%), 7648 (35.9%), 2725 (12.8%), and 763 (3.6%) experienced episodes of serum potassium <3.5, ≥5.0, ≥5.5, and ≥6.0 mmol/L, respectively. The adjusted IRRs for mortality exhibited a U‐shaped association pattern with serum potassium. Relative to the reference category (4.5 to <5.0 mmol/L), adjusted IRRs for mortality were estimated as 1.98 (95% confidence interval: 1.69–2.33), 1.23 (1.12–1.36), 1.35 (1.14–1.60), and 3.02 (2.28–4.02), for patients with serum potassium <3.5, ≥5.0 to <5.5, ≥5.5 to <6.0, and ≥6.0 mmol/L, respectively. The adjusted IRRs for major adverse cardiac events demonstrated a non‐statistically significant relationship with serum potassium. Discontinuation of RAASi therapy exhibited a J‐shaped trend in association with serum potassium. Compared with the reference category (4.5 to <5.0 mmol/L), adjusted IRRs were estimated as 1.07 (0.89–1.28) in patients with serum potassium <3.5 mmol/L, increasing to 1.32 (1.14–1.53) and 2.19 (1.63–2.95) among those with serum potassium ≥5.5 to <6.0 and ≥6.0 mmol/L, respectively.

Conclusions: In UK patients with new onset heart failure, both hypokalaemia and hyperkalaemia were associated with increased mortality risk, and hyperkalaemia was associated with increased likelihood of RAASi discontinuation. Our results demonstrate the potential importance of serum potassium monitoring for heart failure outcomes and management.

Keywords
Hyperkalaemia, Serum potassium, Heart failure, Mortality, Renin-angiotensin-aldosterone system inhibitor therapy, Major adverse cardiac event
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-382990 (URN)10.1002/ehf2.12402 (DOI)000464451900006 ()30629342 (PubMedID)
Funder
AstraZeneca
Available from: 2019-05-13 Created: 2019-05-13 Last updated: 2019-05-13Bibliographically approved
Evans, M., Palaka, E., Furuland, H., Bennett, H., Linde, C., Qin, L., . . . Bakhai, A. (2019). The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease. BMC Nephrology, 20, Article ID 31.
Open this publication in new window or tab >>The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease
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2019 (English)In: BMC Nephrology, ISSN 1471-2369, E-ISSN 1471-2369, Vol. 20, article id 31Article in journal (Refereed) Published
Abstract [en]

Background

People with chronic kidney disease (CKD) are at an increased risk of developing hyperkalaemia due to their declining kidney function. In addition, these patients are often required to reduce or discontinue guideline-recommended renin-angiotensin-aldosterone system inhibitor (RAASi) therapy due to increased risk of hyperkalaemia. This original research developed a model to quantify the health and economic benefits of maintaining normokalaemia and enabling optimal RAASi therapy in patients with CKD.

Methods

A patient-level simulation model was designed to fully characterise the natural history of CKD over a lifetime horizon, and predict the associations between serum potassium levels, RAASi use and long-term outcomes based on published literature. The clinical and economic benefits of maintaining sustained potassium levels and therefore avoiding RAASi discontinuation in CKD patients were demonstrated using illustrative, sensitivity and scenario analyses.

Results

Internal and external validation exercises confirmed the predictive capability of the model. Sustained potassium management and ongoing RAASi therapy were associated with longer life expectancy (+ 2.36 years), delayed onset of end stage renal disease (+ 5.4 years), quality-adjusted life-year gains (+ 1.02 QALYs), cost savings (£3135) and associated net monetary benefit (£23,446 at £20,000 per QALY gained) compared to an absence of RAASi to prevent hyperkalaemia.

Conclusion

This model represents a novel approach to predicting the long-term benefits of maintaining normokalaemia and enabling optimal RAASi therapy in patients with CKD, irrespective of the strategy used to achieve this target, which may support decision making in healthcare.

Keywords
Chronic kidney disease, Potassium, Hyperkalaemia, Renin-angiotensin-aldosterone system inhibitor, Economic modelling
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-377338 (URN)10.1186/s12882-019-1228-y (DOI)000457382600004 ()30704421 (PubMedID)
Funder
AstraZeneca
Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-02-25Bibliographically approved
Jensen, G., Göransson, L. G., Femström, A., Furuland, H. & Christensen, J. H. (2019). Treatment of iron deficiency in patients with chronic kidney disease: A prospective observational study of iron isomaltoside (NIMO Scandinavia). Clinical Nephrology, 91(4), 246-253
Open this publication in new window or tab >>Treatment of iron deficiency in patients with chronic kidney disease: A prospective observational study of iron isomaltoside (NIMO Scandinavia)
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2019 (English)In: Clinical Nephrology, ISSN 0301-0430, Vol. 91, no 4, p. 246-253Article in journal (Refereed) Published
Abstract [en]

Aims: Iron deficiency is common in patients with chronic kidney disease (CKD). Appropriate iron substitution is critical and intravenous iron is an established therapy for these patients. The objective of this study was to assess treatment routine, effectiveness, and safety of iron isomaltoside (Monofer (R), Pharmacosmos A/S, Holbaek, Denmark) in CKD patients in clinical practice.

Materials and methods: This was a prospective observational study conducted in predialysis CKD patients treated with iron isomaltoside according to the product label and to routine clinical care.

Results: The study included 108 patients with predialysis CKD: 22 were in stage 2 - 3, 41 in stage 4, and 45 in stage 5. The mean (standard deviation) age was 67 (15) years, and 55% of patients were male. The majority of patients (65%) received one iron isomaltoside treatment In patients with a baseline Hb < 10 g/dL, the mean dose of iron isomaltoside in the study was lower than the estimated total iron requirement (567 mg versus 921 mg). A treatment response of Hb >= 1 g/dL was achieved in 16/28 (57%) of patients, and the mean post-treatment Hb level was 10.5 g/dL. The probability of retreatment did not correlate with dose, but no dose administered was > 1,000 mg. There were no serious adverse drug reactions. One nonserious adverse drug reaction - injection site discoloration - was reported, and the patient had an uneventful recovery.

Conclusion: Iron isomaltoside shows a good effectiveness and safety profile in predialysis CKD patients. However, some patients did not receive adequate iron doses to allow for optimal correction of their iron deficiency anemia.

Place, publisher, year, edition, pages
DUSTRI-VERLAG DR KARL FEISTLE, 2019
Keywords
chronic renal failure, hemoglobin, intravenous iron, iron deficiency anemia, iron isomaltoside
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-381119 (URN)10.5414/CN109474 (DOI)000461758300008 ()30614439 (PubMedID)
Available from: 2019-04-04 Created: 2019-04-04 Last updated: 2019-04-04Bibliographically approved
Bakhai, A., Palaka, E., Linde, C., Bennett, H., Furuland, H., Qin, L., . . . Ewans, M. (2018). Development of a health economic model to evaluate the potential benefits of optimal serum potassium management in patients with heart failure.. Journal of Medical Economics, 21(12), 1172-1182
Open this publication in new window or tab >>Development of a health economic model to evaluate the potential benefits of optimal serum potassium management in patients with heart failure.
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2018 (English)In: Journal of Medical Economics, ISSN 1369-6998, E-ISSN 1941-837X, Vol. 21, no 12, p. 1172-1182Article in journal (Refereed) Published
Abstract [en]

Aims: Patients with heart failure are at increased risk of hyperkalemia, particularly when treated with renin-angiotensin-aldosterone system inhibitor (RAASi) agents. This study developed a model to quantify the potential health and economic value associated with sustained potassium management and optimal RAASi therapy in heart failure patients.

Materials and methods: A patient-level, fixed-time increment stochastic simulation model was designed to characterize the progression of heart failure through New York Heart Association functional classes, and predict associations between serum potassium levels, RAASi use, and consequent long-term outcomes. Following internal and external validation exercises, model analyses sought to quantify the health and economic benefits of optimizing both serum potassium levels and RAASi therapy in heart failure patients. Analyses were conducted using a UK payer perspective, independent of costs and utilities related to pharmacological potassium management.

Results: Validation against multiple datasets demonstrated the predictive capability of the model. Compared to those who discontinued RAASi to manage serum potassium, patients with normokalemia and ongoing RAASi therapy benefited from longer life expectancy (+1.38 years), per-patient quality-adjusted life year gains (+0.53 QALYs), cost savings (110) pound, and associated net monetary benefit (10,679 pound at 20,000 pound per QALY gained) over a lifetime horizon. The predicted value of sustained potassium management and ongoing RAASi treatment was largely driven by reduced mortality and hospitalization risks associated with optimal RAASi therapy.

Limitations: Several modeling assumptions were made to account for a current paucity of published literature; however, ongoing refinement and validation of the model will ensure its continued accuracy as the clinical landscape of hyperkalemia evolves.

Conclusions: Predictions generated by this novel modeling approach highlight the value of sustained potassium management to avoid hyperkalemia, enable RAASi therapy, and improve long-term health economic outcomes in patients with heart failure.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-363348 (URN)10.1080/13696998.2018.1518239 (DOI)000451594400005 ()30160541 (PubMedID)
Funder
AstraZeneca
Available from: 2018-10-17 Created: 2018-10-17 Last updated: 2019-01-08Bibliographically approved
Stenberg, J., Henriksson, C., Lindberg, M. & Furuland, H. (2018). Perspectives on clinical use of bioimpedance in hemodialysis: focus group interviews with renal care professionals. BMC Nephrology, 19, Article ID 121.
Open this publication in new window or tab >>Perspectives on clinical use of bioimpedance in hemodialysis: focus group interviews with renal care professionals
2018 (English)In: BMC Nephrology, ISSN 1471-2369, E-ISSN 1471-2369, Vol. 19, article id 121Article in journal (Refereed) Published
Abstract [en]

Background

Inadequate volume control may be a main contributor to poor survival and high mortality in hemodialysis patients. Bioimpedance measurement has the potential to improve fluid management, but several dialysis centers lack an agreed fluid management policy, and the method has not yet been implemented. Our aim was to identify renal care professionals’ perceived barriers and facilitators for use of bioimpedance in clinical practice.

Methods

Qualitative data were collected through four focus group interviews with 24 renal care professionals: dieticians, nephrologists and nurses, recruited voluntarily from a nation-wide selection of hemodialysis centers, having access to a bioimpedance-device. The participants were connected to each other and a moderator via equipment for telemedicine and the sessions were recorded. The interviews were semi-structured, focusing on the participants’ perceptions of use of bioimpedance in clinical practice. Thematic content analysis was performed in consecutive steps, and data were extracted by employing an inductive, interactive, comparative process.

Results

Several barriers and facilitators to the use of bioimpedance in clinical practice were identified, and a multilevel approach to examining barriers and incentives for change was found to be applicable to the ideas and categories that arose from the data. The determinants were categorized on five levels, and the different themes of the levels illustrated with quotations from the focus groups participants.

Conclusions

Determinants for use of bioimpedance were identified on five levels: 1) the innovation itself, 2) the individual professional, 3) the patient, 4) the social context and 5) the organizational context. Barriers were identified in the areas of credibility, awareness, knowledge, self-efficacy, care processes, organizational structures and regulations. Facilitators were identified in the areas of the innovation’s attractiveness, advantages in practice, and collaboration. Motivation, team processes and organizational capacities appeared as both barriers and facilitators.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Barriers, Bioimpedance, Dry weight, Facilitators, Focus groups, Renal dialysis
National Category
Urology and Nephrology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-351359 (URN)10.1186/s12882-018-0907-4 (DOI)000433236500004 ()29792174 (PubMedID)
Available from: 2018-05-24 Created: 2018-05-24 Last updated: 2019-01-21Bibliographically approved
Furuland, H., McEwan, P., Evans, M., Linde, C., Ayoubkhani, D., Bakhai, A., . . . Qin, L. (2018). RECURRENT HYPERKALAEMIA AND ASSOCIATION WITH LENGTH-OF-STAY AND MORTALITY FOLLOWING HOSPITALISATION: REAL-WORLD EVIDENCE FROM UK PATIENTS WITH CKD. Paper presented at 55th ERA-EDTA Congress, MAY 24-27, 2018, Copenhagen, DENMARK. Nephrology, Dialysis and Transplantation, 33(Supplement: 1), 157-157
Open this publication in new window or tab >>RECURRENT HYPERKALAEMIA AND ASSOCIATION WITH LENGTH-OF-STAY AND MORTALITY FOLLOWING HOSPITALISATION: REAL-WORLD EVIDENCE FROM UK PATIENTS WITH CKD
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2018 (English)In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 33, no Supplement: 1, p. 157-157Article in journal, Meeting abstract (Other academic) Published
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-362658 (URN)10.1093/ndt/gfy104.FP371 (DOI)000433059800435 ()
Conference
55th ERA-EDTA Congress, MAY 24-27, 2018, Copenhagen, DENMARK
Note

Meeting Abstract: FP371

Available from: 2018-10-16 Created: 2018-10-16 Last updated: 2018-10-16Bibliographically approved
Linde, C., McEwan, P., Bakhai, A., Furuland, H., Evans, M., Ayoubkhani, D., . . . Qin, L. (2018). RELATIONSHIP BETWEEN HYPERKALAEMIA AND DOWN-TITRATION OR DISCONTINUATION OF RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS IN UK PATIENTS WITH CKD. Paper presented at 55th ERA-EDTA Congress, MAY 24-27, 2018, Copenhagen, DENMARK. Nephrology, Dialysis and Transplantation, 33(Supplement: 1), 145-145
Open this publication in new window or tab >>RELATIONSHIP BETWEEN HYPERKALAEMIA AND DOWN-TITRATION OR DISCONTINUATION OF RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS IN UK PATIENTS WITH CKD
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2018 (English)In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 33, no Supplement: 1, p. 145-145Article in journal, Meeting abstract (Other academic) Published
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-362657 (URN)10.1093/ndt/gfy104.FP337 (DOI)000433059800401 ()
Conference
55th ERA-EDTA Congress, MAY 24-27, 2018, Copenhagen, DENMARK
Note

Meeting Abstract: FP337

Available from: 2018-10-16 Created: 2018-10-16 Last updated: 2018-10-16Bibliographically approved
Furuland, H., McEwan, P., Evans, M., Linde, C., Ayoubkhani, D., Bakhai, A., . . . Qin, L. (2018). Serum potassium as a predictor of adverse clinical outcomes in patients with chronic kidney disease: new risk equations using the UK clinical practice research datalink. BMC Nephrology, 19, Article ID 211.
Open this publication in new window or tab >>Serum potassium as a predictor of adverse clinical outcomes in patients with chronic kidney disease: new risk equations using the UK clinical practice research datalink
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2018 (English)In: BMC Nephrology, ISSN 1471-2369, E-ISSN 1471-2369, Vol. 19, article id 211Article in journal (Refereed) Published
Abstract [en]

Background: To address a current paucity of European data, this study developed equations to predict risks of mortality, major adverse cardiac events (MACE) and renin angiotensin-aldosterone system inhibitor (RAASi) discontinuation using time-varying serum potassium and other covariates, in a UK cohort of chronic kidney disease (CKD) patients.

Methods: This was a retrospective observational study of adult CKD patients listed on the Clinical Practice Research Datalink, with a first record of CKD (stage 3a-5, pre-dialysis) between 2006 and 2015. Patients with heart failure at index were excluded. Risk equations developed using Poisson Generalized Estimating Equations were utilised to estimate adjusted incident rate ratios (IRRs) between serum potassium and adverse outcomes, and identify other predictive clinical factors.

Results: Among 191,964 eligible CKD patients, 86,691 (45.16%), 30,629 (15.96%) and 9440 (4.92%) experienced at least one hyperkalaemia episode, when defined using serum potassium concentrations 5.0-< 55 mmol/L, 55-< 6.0 mmol/L and >= 6.0 mmol/L, respectively. Relative to the reference category (4.5 to < 5.0 mmol/L), adjusted IRRs for mortality and MACE exhibited U-shaped associations with serum potassium, with age being the most important predictor of both outcomes (P < 0.0001). A J-shaped association between serum potassium and RAASi discontinuation was observed; estimated glomerular filtration rate was most predictive of RAASi discontinuation (P < 0.0001).

Conclusions: Hyperkalaemia was associated with increased mortality and RAASi discontinuation risk These risk equations represent a valuable tool to predict clinical outcomes among CKD patients; and identify those likely to benefit from strategies that treat hyperkalaemia, prevent RAASi discontinuation, and effectively manage serum potassium levels.

National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-363346 (URN)10.1186/s12882-018-1007-1 (DOI)000442368400001 ()30134846 (PubMedID)
Funder
AstraZeneca
Available from: 2018-10-17 Created: 2018-10-17 Last updated: 2018-10-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9001-614x

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