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Hyperkalemia in pediatric chronic kidney disease

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Abstract

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 ≥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 CO2, 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 <0.001) and hyperkalemia in 6.6% of participants with CKD stage 4/5. Hyperkalemia was present in 14.3% of visits with CKD stage 4/5 and glomerular disease. Hyperkalemia was associated with low CO2 (OR 7.72, 95%CI 3.05–19.54), CKD stage 4/5 (OR 9.17, 95%CI 4.02–20.89), and use of ACEi/ARB therapy (OR 2.14, 95%CI 1.36–3.37). Those with non-glomerular disease were less frequently hyperkalemic (OR 0.52, 95%CI 0.34–0.80). Age, sex, and race/ethnicity were not associated with hyperkalemia.

Conclusions

Hyperkalemia was observed more frequently in children with advanced stage CKD, glomerular disease, low CO2, 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

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Data Availability

Data in this manuscript were collected by the Chronic Kidney Disease in children prospective cohort study (CKiD) and can be requested via the CKiD website (https://statepi.jhsph.edu/ckid).

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Acknowledgements

Data in this manuscript were collected by the Chronic Kidney Disease in children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children’s Mercy Hospital and the University of Missouri—Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD and Derek Ng, PhD) at the Johns Hopkins Bloomberg School of Public Health.

Funding

The CKiD Study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01 DK066143, U01 DK066174, U24 DK082194, U24 DK066116). The CKiD website is located at https://statepi.jhsph.edu/ckid and a list of CKiD collaborators can be found at https://statepi.jhsph.edu/ckid/site-investigators/ and in the Supplemental Material.

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology, Children’s Mercy Kansas City, Kansas City, MO, USA

    Katherine L Kurzinski & Bradley A Warady

  2. Department of Epidemiology, John’s Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Yunwen Xu & Derek K Ng

  3. Division of Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Susan L Furth

  4. Division of Pediatric Nephrology, University of Rochester Medical Center, Rochester, NY, USA

    George J Schwartz

Authors
  1. Katherine L Kurzinski
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for the CKiD Study Investigators

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Katherine Kurzinski, Yunwen Xu, Derek Ng, and Bradley Warady. The first draft of the manuscript was written by Katherine Kurzinski and Bradley Warady, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bradley A Warady.

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Ethics/IRB approval

CKiD protocols and sites were approved by local site Institutional Review Boards (IRBs) and informed consent and assent were provided by all parents and appropriately-aged participants.

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The authors declare no competing interests.

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Kurzinski, K.L., Xu, Y., Ng, D.K. et al. Hyperkalemia in pediatric chronic kidney disease. Pediatr Nephrol 38, 3083–3090 (2023). https://doi.org/10.1007/s00467-023-05912-2

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  • DOI: https://doi.org/10.1007/s00467-023-05912-2

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