Competing-Risk Analysis of Death and End Stage Kidney Disease by Hyperkalaemia Status in Non-Dialysis Chronic Kidney Disease Patients Receiving Stable Nephrology Care
Hyperkalaemia burden in non-dialysis chronic kidney disease (CKD) under nephrology care is undefined. We prospectively followed 2443 patients with two visits (referral and control with 12-month interval) in 46 nephrology clinics. Patients were stratified in four categories of hyperkalaemia (serum po...
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doaj-f229cfd4804e4e3fbfb3f141f9186b4c2020-11-24T21:33:18ZengMDPI AGJournal of Clinical Medicine2077-03832018-12-0171249910.3390/jcm7120499jcm7120499Competing-Risk Analysis of Death and End Stage Kidney Disease by Hyperkalaemia Status in Non-Dialysis Chronic Kidney Disease Patients Receiving Stable Nephrology CareMichele Provenzano0Roberto Minutolo1Paolo Chiodini2Vincenzo Bellizzi3Felice Nappi4Domenico Russo5Silvio Borrelli6Carlo Garofalo7Carmela Iodice8Toni De Stefano9Giuseppe Conte10Hiddo J. L. Heerspink11Luca De Nicola12Division of Nephrology, Department of Advanced Medical and Surgical Sciences, Nephrology Unit-University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyDivision of Nephrology, Department of Advanced Medical and Surgical Sciences, Nephrology Unit-University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyMedical Statistics Unit, the University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyNephrology Unit, Hospital Ruggi d’Aragona, 84131 Salerno, ItalyNephrology Unit, Hospital Santa Maria della Pietà, 80035 Nola, ItalyNephrology Unit, Department of Public Health, University Federico II of Naples, 80131 Naples, ItalyDivision of Nephrology, Department of Advanced Medical and Surgical Sciences, Nephrology Unit-University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyDivision of Nephrology, Department of Advanced Medical and Surgical Sciences, Nephrology Unit-University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyDivision of Nephrology, Department of Advanced Medical and Surgical Sciences, Nephrology Unit-University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyDivision of Nephrology, Department of Advanced Medical and Surgical Sciences, Nephrology Unit-University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyDivision of Nephrology, Department of Advanced Medical and Surgical Sciences, Nephrology Unit-University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyDepartment of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, 9727 Groningen, The NetherlandsDivision of Nephrology, Department of Advanced Medical and Surgical Sciences, Nephrology Unit-University of Campania “Luigi Vanvitelli”, 80138 Naples, ItalyHyperkalaemia burden in non-dialysis chronic kidney disease (CKD) under nephrology care is undefined. We prospectively followed 2443 patients with two visits (referral and control with 12-month interval) in 46 nephrology clinics. Patients were stratified in four categories of hyperkalaemia (serum potassium, sK ≥ 5.0 mEq/L) by sK at visit 1 and 2: Absent (no-no), Resolving (yes-no), New Onset (no-yes), Persistent (yes-yes). We assessed competing risks of end stage kidney disease (ESKD) and death after visit 2. Age was 65 ± 15 years, eGFR 35 ± 17 mL/min/1.73 m<sup>2</sup>, proteinuria 0.40 (0.14–1.21) g/24 h. In the two visits sK was 4.8 ± 0.6 and levels ≥6 mEq/L were observed in 4%. Hyperkalaemia was absent in 46%, resolving 17%, new onset 15% and persistent 22%. Renin-angiotensin-system inhibitors (RASI) were prescribed in 79% patients. During 3.6-year follow-up, 567 patients reached ESKD and 349 died. Multivariable competing risk analysis (sub-hazard ratio-sHR, 95% Confidence Interval-CI) evidenced that new onset (sHR 1.34, 95% CI 1.05–1.72) and persistent (sHR 1.27, 95% CI 1.02–1.58) hyperkalaemia predicted higher ESKD risk versus absent, independently from main determinants of outcome including eGFR change. Conversely, no effect on mortality was observed. Results were confirmed by testing sK as continuous variable. Therefore, in CKD under nephrology care, mild-to-moderate hyperkalaemia status is common (37%) and predicts per se higher ESKD risk but not mortality.https://www.mdpi.com/2077-0383/7/12/499CKDESKDdeathanti-RAShyperkalaemiacompeting risk |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Michele Provenzano Roberto Minutolo Paolo Chiodini Vincenzo Bellizzi Felice Nappi Domenico Russo Silvio Borrelli Carlo Garofalo Carmela Iodice Toni De Stefano Giuseppe Conte Hiddo J. L. Heerspink Luca De Nicola |
spellingShingle |
Michele Provenzano Roberto Minutolo Paolo Chiodini Vincenzo Bellizzi Felice Nappi Domenico Russo Silvio Borrelli Carlo Garofalo Carmela Iodice Toni De Stefano Giuseppe Conte Hiddo J. L. Heerspink Luca De Nicola Competing-Risk Analysis of Death and End Stage Kidney Disease by Hyperkalaemia Status in Non-Dialysis Chronic Kidney Disease Patients Receiving Stable Nephrology Care Journal of Clinical Medicine CKD ESKD death anti-RAS hyperkalaemia competing risk |
author_facet |
Michele Provenzano Roberto Minutolo Paolo Chiodini Vincenzo Bellizzi Felice Nappi Domenico Russo Silvio Borrelli Carlo Garofalo Carmela Iodice Toni De Stefano Giuseppe Conte Hiddo J. L. Heerspink Luca De Nicola |
author_sort |
Michele Provenzano |
title |
Competing-Risk Analysis of Death and End Stage Kidney Disease by Hyperkalaemia Status in Non-Dialysis Chronic Kidney Disease Patients Receiving Stable Nephrology Care |
title_short |
Competing-Risk Analysis of Death and End Stage Kidney Disease by Hyperkalaemia Status in Non-Dialysis Chronic Kidney Disease Patients Receiving Stable Nephrology Care |
title_full |
Competing-Risk Analysis of Death and End Stage Kidney Disease by Hyperkalaemia Status in Non-Dialysis Chronic Kidney Disease Patients Receiving Stable Nephrology Care |
title_fullStr |
Competing-Risk Analysis of Death and End Stage Kidney Disease by Hyperkalaemia Status in Non-Dialysis Chronic Kidney Disease Patients Receiving Stable Nephrology Care |
title_full_unstemmed |
Competing-Risk Analysis of Death and End Stage Kidney Disease by Hyperkalaemia Status in Non-Dialysis Chronic Kidney Disease Patients Receiving Stable Nephrology Care |
title_sort |
competing-risk analysis of death and end stage kidney disease by hyperkalaemia status in non-dialysis chronic kidney disease patients receiving stable nephrology care |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2018-12-01 |
description |
Hyperkalaemia burden in non-dialysis chronic kidney disease (CKD) under nephrology care is undefined. We prospectively followed 2443 patients with two visits (referral and control with 12-month interval) in 46 nephrology clinics. Patients were stratified in four categories of hyperkalaemia (serum potassium, sK ≥ 5.0 mEq/L) by sK at visit 1 and 2: Absent (no-no), Resolving (yes-no), New Onset (no-yes), Persistent (yes-yes). We assessed competing risks of end stage kidney disease (ESKD) and death after visit 2. Age was 65 ± 15 years, eGFR 35 ± 17 mL/min/1.73 m<sup>2</sup>, proteinuria 0.40 (0.14–1.21) g/24 h. In the two visits sK was 4.8 ± 0.6 and levels ≥6 mEq/L were observed in 4%. Hyperkalaemia was absent in 46%, resolving 17%, new onset 15% and persistent 22%. Renin-angiotensin-system inhibitors (RASI) were prescribed in 79% patients. During 3.6-year follow-up, 567 patients reached ESKD and 349 died. Multivariable competing risk analysis (sub-hazard ratio-sHR, 95% Confidence Interval-CI) evidenced that new onset (sHR 1.34, 95% CI 1.05–1.72) and persistent (sHR 1.27, 95% CI 1.02–1.58) hyperkalaemia predicted higher ESKD risk versus absent, independently from main determinants of outcome including eGFR change. Conversely, no effect on mortality was observed. Results were confirmed by testing sK as continuous variable. Therefore, in CKD under nephrology care, mild-to-moderate hyperkalaemia status is common (37%) and predicts per se higher ESKD risk but not mortality. |
topic |
CKD ESKD death anti-RAS hyperkalaemia competing risk |
url |
https://www.mdpi.com/2077-0383/7/12/499 |
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