Aims Both hypo- and hyperkalaemia can have immediate deleterious physiological effects, and less is known about long-term risks. The objective was to determine the risks of all-cause mortality, cardiovascular mortality, and end-stage renal disease associated with potassium levels across the range of kidney function and evaluate for consistency across cohorts in a global consortium. Methods and results We performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high cardiovascular risk, and 10 chronic kidney disease (CKD)] in the CKD Prognosis Consortium. We used Cox regression followed by random-effects meta-analysis to assess the relationship between baseline potassium and adverse outcomes, adjusted for demographic and clinical characteristics, overall and across strata of estimated glomerular filtration rate (eGFR) and albuminuria. We included 1 217 986 participants followed up for a mean of 6.9 years. The average age was 55 ± 16 years, average eGFR was 83 ± 23 mL/min/1.73 m2, and 17% had moderate- to-severe increased albuminuria levels. The mean baseline potassium was 4.2 ± 0.4 mmol/L. The risk of serum potassium of >5.5 mmol/L was related to lower eGFR and higher albuminuria. The risk relationship between potassium levels and adverse outcomes was U-shaped, with the lowest risk at serum potassium of 4-4.5 mmol/L. Compared with a reference of 4.2 mmol/L, the adjusted hazard ratio for all-cause mortality was 1.22 [95% confidence interval (CI) 1.15-1.29] at 5.5 mmol/L and 1.49 (95% CI 1.26-1.76) at 3.0 mmol/L. Risks were similar by eGFR, albuminuria, renin-angiotensin-aldosterone system inhibitor use, and across cohorts. Conclusions Outpatient potassium levels both above and below the normal range are consistently associated with adverse outcomes, with similar risk relationships across eGFR and albuminuria.

中文翻译：

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血清钾和肾功能范围内的不良结果：CKD 预后联盟的荟萃分析

目的 低钾血症和高钾血症均会立即产生有害的生理影响，而对长期风险知之甚少。目的是确定与肾功能范围内钾水平相关的全因死亡率、心血管死亡率和终末期肾病的风险，并评估全球联盟中各队列的一致性。方法和结果 我们对 CKD 预后联盟中的 27 个国际队列 [10 个普通人群、7 个高心血管风险和 10 个慢性肾病 (CKD)] 进行了个人水平的数据荟萃分析。我们使用 Cox 回归和随机效应荟萃分析来评估基线钾和不良结果之间的关系，根据人口统计学和临床​​特征进行调整，估计肾小球滤过率 (eGFR) 和蛋白尿的整体和跨层。我们纳入了 1 217 986 名参与者，平均随访时间为 6.9 年。平均年龄为 55 ± 16 岁，平均 eGFR 为 83 ± 23 mL/min/1.73 m2，17% 的白蛋白尿水平中度至重度升高。平均基线钾为 4.2 ± 0.4 mmol/L。血钾>5.5 mmol/L 的风险与较低的 eGFR 和较高的蛋白尿有关。钾水平与不良结局之间的风险关系呈 U 型，血清钾水平为 4-4.5 mmol/L 时风险最低。与参考值 4.2 mmol/L 相比，调整后的全因死亡率风险比为 5.5 mmol/L 时的 1.22 [95% 置信区间 (CI) 1.15-1.29] 和 3.0 时的 1.49 (95% CI 1.26-1.76)毫摩尔/升。eGFR、蛋白尿、肾素-血管紧张素-醛固酮系统抑制剂的使用，以及跨队列。结论 高于和低于正常范围的门诊患者钾水平始终与不良结果相关，eGFR 和蛋白尿的风险关系相似。