@article {7347, title = {The Relation of Serum Potassium Concentration with Cardiovascular Events and Mortality in Community-Living Individuals.}, journal = {Clin J Am Soc Nephrol}, volume = {12}, year = {2017}, month = {2017 Feb 07}, pages = {245-252}, abstract = {

BACKGROUND AND OBJECTIVES: Hyperkalemia is associated with adverse outcomes in patients with CKD and in hospitalized patients with acute medical conditions. Little is known regarding hyperkalemia, cardiovascular disease (CVD), and mortality in community-living populations. In a pooled analysis of two large observational cohorts, we investigated associations between serum potassium concentrations and CVD events and mortality, and whether potassium-altering medications and eGFR<60 ml/min per 1.73 m(2) modified these associations.

DESIGN, SETTING, PARTICIPANTS, \& MEASUREMENTS: Among 9651 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Cardiovascular Health Study (CHS), who were free of CVD at baseline (2000-2002 in the MESA and 1989-1993 in the CHS), we investigated associations between serum potassium categories (<3.5, 3.5-3.9, 4.0-4.4, 4.5-4.9, and >=5.0 mEq/L) and CVD events, mortality, and mortality subtypes (CVD versus non-CVD) using Cox proportional hazards models, adjusting for demographics, time-varying eGFR, traditional CVD risk factors, and use of potassium-altering medications.

RESULTS: Compared with serum potassium concentrations between 4.0 and 4.4 mEq/L, those with concentrations >=5.0 mEq/L were at higher risk for all-cause mortality (hazard ratio, 1.41; 95\% confidence interval, 1.12 to 1.76), CVD death (hazard ratio, 1.50; 95\% confidence interval, 1.00 to 2.26), and non-CVD death (hazard ratio, 1.40; 95\% confidence interval, 1.07 to 1.83) in fully adjusted models. Associations of serum potassium with these end points differed among diuretic users (Pinteraction<0.02 for all), such that participants who had serum potassium >=5.0 mEq/L and were concurrently using diuretics were at higher risk of each end point compared with those not using diuretics.

CONCLUSIONS: Serum potassium concentration >=5.0 mEq/L was associated with all-cause mortality, CVD death, and non-CVD death in community-living individuals; associations were stronger in diuretic users. Whether maintenance of potassium within the normal range may improve clinical outcomes requires future study.

}, issn = {1555-905X}, doi = {10.2215/CJN.06290616}, author = {Hughes-Austin, Jan M and Rifkin, Dena E and Beben, Tomasz and Katz, Ronit and Sarnak, Mark J and Deo, Rajat and Hoofnagle, Andrew N and Homma, Shunichi and Siscovick, David S and Sotoodehnia, Nona and Psaty, Bruce M and de Boer, Ian H and Kestenbaum, Bryan and Shlipak, Michael G and Ix, Joachim H} }