Background: Understanding the prevalence and risk factors for hyperkalemia is critical for public health policy, especially given the burgeoning interest in use of potassium-enriched salt substitutes as a means to reduce sodium intake. Importantly, data on the prevalence of hyperkalemia in the US are sparse, overall and in high-risk subgroups. Aim: To investigate the prevalence, temporal trends, and risk factors for hyperkalemia in the US using nationally representative data. Method: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2001 through 2023. Hyperkalemia was defined as a serum potassium levels >5.0 mmol/L. Prevalence of hyperkalemia was estimated overall and by survey cycle using logistic regression. Candidate predictors of hyperkalemia, including hypertension, chronic kidney disease (CKD), diabetes, sex, age, race/ethnicity, alcohol use, smoking status, renin–angiotensin–aldosterone system (RAAS) inhibitors, were examined in crude models. Then, significant factors were incorporated simultaneously in a multivariable model and presented, along with the prevalence of hyperkalemia in each relevant subgroup. All analyses incorporated sampling weights. Results: Among 45,778 U.S. adults aged 20 years and older pooled across the 2001–2023 NHANES survey cycles, 373 had hyperkalemia. The overall prevalence of hyperkalemia was 0.46% (95% CI 0.29-0.71%). Although the prevalence of hyperkalemia appeared to be increasing from 0.16% (0.07-0.33%) in 2005-2006 to 0.75% (0.46-1.21%) in 2017-2020 ( Figure ), in the entire two decades, its prevalence was largely constant between 0.3% and 0.6%, with no clear temporal trend ( P for trend = 0.07). Factors significantly associated with hyperkalemia included CKD, older age, and male sex ( Table ). Non-White racial/ethnic groups and current alcohol users showed lower prevalence compared to their counterparts. The only subgroups with the prevalence of hyperkalemia exceeding 1% were people with CKD and older adults (≥65 years). Conclusion: The overall low prevalence of hyperkalemia without evident temporal trend supports the safety of promoting potassium-enriched salt substitutes among U.S. adults. However, careful implementation may be warranted for individuals with risk factors, such as CKD, older age, and male sex. In contrast, racial/ethnic minorities and current alcohol users showed a lower prevalence of hyperkalemia and could particularly benefit from potassium-enriched salt substitutes.
Guan et al. (Tue,) studied this question.