Urinary Potassium excretion and progression of CKD

Hyung Woo Kim, Jung Tak Park, Tae Hyun Yoo, Joongyub Lee, Wookyung Chung, Kyu Beck Lee, Dong Wan Chae, Curie Ahn, Shin Wook Kang, Kyu Hun Choi, Seung Hyeok Han

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35 Citations (Scopus)


Background and objectives Data on whether low or high urinary potassium excretion is associated with poor kidney outcome have been conflicting. The aim of this study was to clarify the association between urinary potassium excretion and CKD progression. Design, setting, participants, & measurements We investigated the relationship between lower urinary potassiumexcretion andCKDprogression andcompared threeurinarypotassiumindicesamong1821patients from the Korean Cohort Study for Outcome in Patients with CKD. Urinary potassium excretion was determined using spot urinary potassium-to-creatinine ratio, spot urinary potassium concentration, and 24-hour urinary potassiumexcretion. Patientswere categorized into four groups according to quartiles of each urinary potassium excretion metric. The study end point was a composite of a ≥50% decrease in eGFR from baseline values and ESKD. Results During 5326 person-years of follow-up, the primary outcome occurred in 392 (22%) patients. In a multivariable cause-specific hazard model, lower urinary potassium-to-creatinine ratio was associated with higher risk of CKD progression (adjusted hazard ratio, 1.47; 95% confidence interval, 1.01 to 2.12) comparing the lowest quartile with the highest quartile. Sensitivity analyses with other potassium metrics also showed consistent results in 855 patients who completed 24-hour urinary collections: adjusted hazard ratios comparing the lowest quartile with the highest quartile were 3.05 (95% confidence interval, 1.54 to 6.04) for 24-hour urinary potassium excretion, 1.95 (95% confidence interval, 1.05 to 3.62) for spot urinary potassium-to-creatinine ratio, and 3.79 (95% confidence interval, 1.51 to 9.51) for spot urinary potassium concentration. Conclusions Low urinary potassium excretion is associated with progression of CKD.

Original languageEnglish
Pages (from-to)330-340
Number of pages11
JournalClinical Journal of the American Society of Nephrology
Issue number3
Publication statusPublished - 2019 Mar 7

Bibliographical note

Funding Information:
This work was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (grants 2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, 2016E3300200, and 2016E3300201).

Publisher Copyright:
© 2019 by the American Society of Nephrology.

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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