Prevalence of hyperkalemia in diabetic and non-diabetic patients with chronic kidney disease

In the present prospective observational study, the prevalence of hyperkalemia and the factors associated with its occurrence were evaluated in patients with CKD stages 2–4. A total of 323 consecutive patients with stable CKD stages 2–4 who attended the regular outpatient clinics of the 2nd Department of Nephrology, Aristotle University of Thessaloniki, were included. Serum potassium levels and other laboratory parameters, demographic data, medical history, and medication use were recorded. Hyperkalemia was defined as serum potassium levels ≥5.5 mEq/L or the use of a potassium-binding agent in the intestine. Independent determinants of hyperkalemia in the study population were investigated using multivariate logistic regression analysis.The patients had a mean age of 70.9 ± 11.2 years (33% women), a mean serum potassium level of 4.68 ± 0.55 mEq/L, a mean eGFR of 42.4 ± 15.8 mL/min/1.73 m², and 48% had diabetes mellitus. Hyperkalemia was observed in 13.9% of patients. In multivariate logistic regression analysis, older age was associated with a higher likelihood of hyperkalemia odds ratio (OR): 1.034, 95% confidence interval (CI): 1.000–1.068, whereas higher eGFR levels were associated with a lower risk of hyperkalemia (OR: 0.966, 95% CI: 0.945–0.989). A history of diabetes mellitus and the use of renin–angiotensin–aldosterone system inhibitors did not remain independent determinants of hyperkalemia after adjustment for other risk factors.This study shows that hyperkalemia was present in approximately 14% of patients with CKD stages 2–4. Advanced age and reduced eGFR appear to be the two main determinants of hyperkalemia in this patient population.