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Competing-Risk Analysis of Death and End Stage Kidney Disease by Hyperkalaemia Status in Non-Dialysis Chronic Kidney Disease Patients Receiving Stable Nephrology Care

1
Division of Nephrology, Department of Advanced Medical and Surgical Sciences, Nephrology Unit-University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
2
Medical Statistics Unit, the University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
3
Nephrology Unit, Hospital Ruggi d’Aragona, 84131 Salerno, Italy
4
Nephrology Unit, Hospital Santa Maria della Pietà, 80035 Nola, Italy
5
Nephrology Unit, Department of Public Health, University Federico II of Naples, 80131 Naples, Italy
6
Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, 9727 Groningen, The Netherlands
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(12), 499; https://doi.org/10.3390/jcm7120499
Received: 6 November 2018 / Revised: 26 November 2018 / Accepted: 27 November 2018 / Published: 1 December 2018
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 m2, 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. View Full-Text
Keywords: CKD; ESKD; death; anti-RAS; hyperkalaemia; competing risk CKD; ESKD; death; anti-RAS; hyperkalaemia; competing risk
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MDPI and ACS Style

Provenzano, M.; Minutolo, R.; Chiodini, P.; Bellizzi, V.; Nappi, F.; Russo, D.; Borrelli, S.; Garofalo, C.; Iodice, C.; De Stefano, T.; Conte, G.; Heerspink, H.J.L.; De Nicola, L. Competing-Risk Analysis of Death and End Stage Kidney Disease by Hyperkalaemia Status in Non-Dialysis Chronic Kidney Disease Patients Receiving Stable Nephrology Care. J. Clin. Med. 2018, 7, 499. https://doi.org/10.3390/jcm7120499

AMA Style

Provenzano M, Minutolo R, Chiodini P, Bellizzi V, Nappi F, Russo D, Borrelli S, Garofalo C, Iodice C, De Stefano T, Conte G, Heerspink HJL, De Nicola L. 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. 2018; 7(12):499. https://doi.org/10.3390/jcm7120499

Chicago/Turabian Style

Provenzano, Michele, 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, and Luca De Nicola. 2018. "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 7, no. 12: 499. https://doi.org/10.3390/jcm7120499

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