Rationale & Objective

The population burden and long-term implications of hyperkalemia have not been comprehensively studied. We studied how often and where hyperkalemia occurs as well as its independent association with survival and long-term cardiac and kidney health.

Study Design

Population-based cohort study of adult residents of Grampian, United Kingdom.

Setting & Participants

Among the 468,594 adult residents (2012-2014), 302,630 people with at least 1 blood test were followed until 2019.

Exposure

Hyperkalemia was defined as serum potassium ≥ 5.5 mmol/L. Adjustment for comorbidities, demographics, measures of acute and chronic kidney function, and medications prescribed before measurement of serum potassium.

Outcome

All-cause mortality, cardiac events, and kidney failure.

Analytical Approach

Description of the annual incidence of hyperkalemia and the characteristics associated with its occurrence, and adjusted Cox proportional hazards (PH) analysis to evaluate the independent long-term association of hyperkalemia with all-cause mortality among people who survived ≥90 days after blood testing. Cause-specific PH models were fit to evaluate the association of hyperkalemia with cardiac events/death, noncardiac death, and kidney failure. Effect modification by level of estimated glomerular filtration rate (eGFR) at the time of blood testing was explored.

Results

The annual population incidence of hyperkalemia was 0.96 per 100 person-years. This represented 2.3%, 2.1%, and 1.9% of people with at least one blood test in 2012, 2013, and 2014, respectively. Two-thirds of episodes of hyperkalemia occurred in the community. The hyperkalemia rate was 2-fold higher for each 10-year greater age. Those with hyperkalemia were 20 times more likely to have concurrent acute kidney injury (AKI), and 17 times more likely to have an eGFR of <30 mL/min/1.73 m². Throughout 5 years of follow-up evaluation (2,483,452 person-years), hyperkalemia was associated with poorer health outcomes. This association held across all levels of kidney function and was irrespective of concurrent AKI, but was stronger among those with a baseline eGFR of ≥60 mL/min/1.73 m² (P for interaction < 0.001). The adjusted HRs (hyperkalemia vs no hyperkalemia) for people with eGFR ≥60 mL/min/1.73 m² and eGFR <30 mL/min/1.73 m² were 2.3 (95% CI, 2.2-2.5) and 1.5 (95% CI, 1.3-1.6) for mortality; 1.8 (95% CI, 1.6-1.9) and 1.4 (95% CI, 1.2-1.6) for cardiac events; and 17.0 (95% CI, 9.3-31.1) and 2.0 (95% CI, 1.5-2.8) for kidney failure, respectively.

Limitations

The observational nature of this study limits evaluation of causal relationships.

Conclusions

There is a substantial burden of hyperkalemia in the general population. Hyperkalemia is associated with poorer long-term health outcomes, especially kidney outcomes, that are independent of other established risk factors.

中文翻译：

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高钾血症人群流行病学：心脏和肾脏长期健康结果

基本原理和目标

高钾血症的人口负担和长期影响尚未得到全面研究。我们研究了高钾血症发生的频率和位置，以及它与生存和长期心脏和肾脏健康的独立关联。

学习规划

对英国格兰屏成年居民的基于人群的队列研究。

设置与参与者

在 468,594 名成年居民（2012-2014 年）中，有 302,630 名至少进行了 1 次血液检查的人被跟踪到 2019 年。

接触

高钾血症定义为血清钾≥5.5 mmol/L。对合并症、人口统计学、急性和慢性肾功能的测量以及血清钾测量前开具的药物进行调整。

结果

全因死亡率、心脏事件和肾衰竭。

分析方法

描述高钾血症的年发病率及其相关特征，并调整 Cox 比例风险 (PH) 分析，以评估血液检测后存活 ≥ 90 天的人群中高钾血症与全因死亡率的独立长期关联。特定原因的 PH 模型适合评估高钾血症与心脏事件/死亡、非心脏性死亡和肾衰竭的关联。探讨了在血液检测时通过估计肾小球滤过率 (eGFR) 水平进行的效果修正。

结果

高钾血症的年人口发病率为 0.96/100 人年。这分别占 2012 年、2013 年和 2014 年至少进行一次血液检查的人的 2.3%、2.1% 和 1.9%。三分之二的高钾血症发作发生在社区。年龄每增加 10 岁，高钾血症发生率增加 2 倍。高钾血症患者并发急性肾损伤 (AKI) 的可能性高 20 倍，eGFR <30 mL/min/1.73 m ²的可能性高 17 倍。在 5 年的随访评估中（2,483,452 人年），高钾血症与较差的健康结果相关。这种关联在所有肾功能水平上都存在，并且与并发 AKI 无关，但在基线 eGFR ≥ 60 mL/min/1.73 m ²的患者中更强（P交互作用 < 0.001）。^{对于 eGFR ≥ 60 mL/min/1.73 m 2}和 eGFR <30 mL/min/1.73 m ²的人，调整后的 HR（高钾血症与无高钾血症）分别为 2.3（95% CI，2.2-2.5）和 1.5（95% CI , 1.3-1.6) 用于死亡率；1.8 (95% CI, 1.6-1.9) 和 1.4 (95% CI, 1.2-1.6) 用于心脏事件；肾衰竭分别为 17.0 (95% CI, 9.3-31.1) 和 2.0 (95% CI, 1.5-2.8)。

限制

本研究的观察性质限制了对因果关系的评估。

结论

高钾血症在普通人群中存在很大负担。高钾血症与较差的长期健康结果相关，尤其是肾脏结果，与其他既定风险因素无关。