Hyperkalemia in pediatric chronic kidney disease

Background While hyperkalemia is well described in adult chronic kidney disease (CKD), large studies evaluating potassium trends and risk factors for hyperkalemia in pediatric CKD are lacking. This study aimed to characterize hyperkalemia prevalence and risk factors in pediatric CKD. Methods Cross-sectional analysis of Chronic Kidney Disease in Children (CKiD) study data evaluated median potassium levels and percentage of visits with hyperkalemia (K [greater than or equal to]5.5 mmoL/L) in relation to demographics, CKD stage, etiology, proteinuria, and acid-base status. Multiple logistic regression was used to identify risk factors for hyperkalemia. Results One thousand and fifty CKiD participants with 5183 visits were included (mean age 13.1 years, 62.7% male, 32.9% self-identifying as African American or Hispanic). A percentage of 76.6% had non-glomerular disease, 18.7% had CKD stage 4/5, 25.8% had low CO.sub.2, and 54.2% were receiving ACEi/ARB therapy. Unadjusted analysis identified a median serum potassium level of 4.5 mmol/L (IQR 4.1-5.0, p Conclusions Hyperkalemia was observed more frequently in children with advanced stage CKD, glomerular disease, low CO.sub.2, and ACEi/ARB use. These data can help clinicians identify high-risk patients who may benefit from earlier initiation of potassium-lowering therapies. Graphical Abstract
Author(s): Katherine L Kurzinski [sup.1] , Yunwen Xu [sup.2] , Derek K Ng [sup.2] , Susan L Furth [sup.3] , George J Schwartz [sup.4] , Bradley A Warady [sup.1] Author [...]