American journal of nephrology
August 28, 2026 · via Europe PMC
Factors Associated with Hyperkalemia in Chronic Kidney Disease: Insights from a Cohort with Measured Glomerular Filtration Rate.
Motiejunaite J, Flamant M, Lahens A, +6 more, Vidal-Petiot E.
AI summary — for doctors, generated from the abstract only
In a large cohort with gold-standard measured GFR, hyperkalemia in CKD was driven primarily by reduced kidney function, diabetes, and use of RAAS inhibitors, while female sex, sub-Saharan African ancestry, and loop diuretics were protective factors.
What was studied
A cross-sectional study of 5,046 adults with non-dialysis CKD referred for kidney workup (including radio-isotopic measured GFR and standardized plasma potassium) identified demographic, clinical, pharmacological, and biochemical risk factors for hyperkalemia (plasma potassium ≥5.0 mmol/L or potassium binder use) using multivariable logistic regression.
Key findings
- Mean measured GFR was 59±26 mL/min/1.73m2; overall hyperkalemia prevalence was 6.4%, rising sharply with declining GFR, from 1% in CKD stages 1-2 to 8% in stage 3 and 21% in stages 4-5.
- Measured GFR remained strongly associated with hyperkalemia (OR 1.65, 95% CI 1.51-1.81 per 10 mL/min/1.73m2 decrease), with this effect amplified in RAAS inhibitor users (OR 1.82, 95% CI 1.61-2.07; p for interaction=0.036).
- Other factors independently associated with higher hyperkalemia risk included diabetes (OR 1.67, 95% CI 1.38-2.17), RAAS inhibitor use (OR 2.30, 95% CI 1.72-3.11), calcineurin inhibitor use (OR 1.39, 95% CI 1.06-1.83), higher urinary albumin-to-creatinine ratio, and lower venous bicarbonate.
- Protective factors included female sex (OR 0.71, 95% CI 0.55-0.92), sub-Saharan African ancestry (HR 0.68, 95% CI 0.48-0.94), and loop diuretic use (OR 0.71, 95% CI 0.51-0.98); age and BMI showed no independent association.
Clinical relevance
The findings, based on gold-standard measured (rather than estimated) GFR, suggest that reduced kidney function, diabetes, and RAAS inhibitor use are the primary drivers of hyperkalemia in CKD, while identifying female sex, sub-Saharan African ancestry, and loop diuretics as protective, which may support more individualized hyperkalemia risk assessment and prevention strategies in clinical practice.
Who should care
Limitations
Cross-sectional design limits ability to establish causality for the identified associations; the cohort was drawn from patients referred for specialized kidney workup, which may not be fully representative of the general CKD population.
In a large cohort with measured GFR, hyperkalemia risk in CKD was driven mainly by reduced kidney function, diabetes, and RAAS inhibitor use, while female sex, sub-Saharan African ancestry, and loop diuretics were protective, supporting individualized hyperkalemia prevention strategies.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Introduction
Hyperkalemia is a life-threatening disorder in chronic kidney disease (CKD), yet the contribution of key factors including age, sex, body mass index and proteinuria remain controversial. We aimed to identify factors associated with chronic hyperkalemia in a large cohort of patients with gold-standard measured glomerular filtration rate (GFR) and standardized plasma potassium measurements.
Methods
This cross-sectional study of 5046 adults with non-dialysis CKD referred for kidney workup, including radio-isotopic measured GFR, defined hyperkalemia as a plasma potassium concentration ≥5.0 mmol/L or the use of potassium binders. We analyzed demographic, clinical, pharmacological and biochemical risk factors for hyperkalemia using logistic regression models.
Results
Mean measured GFR was 59±26 mL/min/1.73 m2, mean age was 52±15 years, 42% were women, 22% of sub-Saharan African ancestry, 25% had diabetes, and 36% were kidney transplant recipients. The prevalence of hyperkalemia was 6.4% and increased with declining measured GFR, from 1% in CKD stages 1-2 to 8% in CKD stage 3 and 21% in stages 4-5. In the multivariable model, measured GFR remained strongly associated with hyperkalemia (OR 1.65 [1.51-1.81] per 10 mL/min/1.73m² decrease), an effect amplified in renin-angiotensin-aldosterone system inhibitor (RAASi) users (1.82 [1.61-2.07]) (p for interaction 0.036). Other independently associated factors were diabetes (OR 1.67 [1.38-2.17]), RAASi and calcineurin inhibitors (OR 2.30 [1.72-3.11] and 1.39 [1.06-1.83] respectively), higher urinary albumin-to-creatinine ratio and lower venous bicarbonate level, whereas female sex (OR 0.71 [0.55-0.92]), sub-Saharan African ancestry (HR 0.68 [0.48-0.94]), and loop-diuretics (OR 0.71 [0.51-0.98]) were protective, and age and body mass index showed no independent association.
Conclusion
In this large cohort, across the entire range of gold-standard measured GFR, hyperkalemia is driven primarily by reduced kidney function, diabetes, and RAASi, whereas protective factors were female sex, sub-Saharan African ancestry, and loop diuretic therapy. These robust findings, based on unbiased GFR assessment, identify key contributors for individualized prevention of hyperkalemia in CKD.
DOI
10.1159/ajn/ablag008
PMID
42664185
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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