Observational studyNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2019
Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine Measurements (SCREAM) project.
Observational study in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
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Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it, 70 citations in OpenAlex.
- Potassium Intake and Blood Pressure: A Dose-Response Meta-Analysis of Randomized Controlled Trials.Journal of the American Heart Association · 2020Pooled it
- Development of a nomogram for predicting hyperkalemia in advanced chronic kidney disease.Renal failure · 2026Article
- [Consensus recommendations on the diagnosis and treatment of hyperkalemia of the Austrian Society of Nephrology 2026].Wiener klinische Wochenschrift · 2026Review
- Urgent initiation of hemodialysis versus peritoneal dialysis in severe hyperkalemia: a prospective study.Clinical kidney journal · 2025Article
- Managing Hypertension in Chronic Kidney Disease: The Role of Diet and Guideline Recommendations.Journal of clinical medicine · 2025Review
- Hyperkalemia burden and treatment patterns in Chinese patients on hemodialysis: final analysis of a prospective multicenter cohort study (PRECEDE-K).Renal failure · 2024Article
- Disorders of potassium homeostasis after kidney transplantation.World journal of transplantation · 2024Review
- Clinical profile and complications seen in the patients in the later stages of chronic kidney disease presenting to the Emergency Department in a tertiary care center in Nepal: a cross-sectional study.Annals of medicine and surgery (2012) · 2024Article
- Gender-specific risk factors and outcomes of hyperkalemia in CKD patients: smoking as a driver of hyperkalemia in men.Clinical kidney journal · 2024Article
- Association between annual variability of potassium levels and prognosis in patients undergoing hemodialysis.Clinical and experimental nephrology · 2023Article
- Impact of serum sodium concentrations, and effect modifiers on mortality in the Irish Health System.BMC nephrology · 2023Article
- Article
- Chronic hyperkalemia, diagnosis and management. Colombian consensus.Archivos de cardiologia de Mexico · 2023Article
- Hyperkalemia and the Use of New Potassium Binders a Single Center Experience from Vestfold Norway (The PotBind Study).International journal of nephrology and renovascular disease · 2023Article
- The Cost Effectiveness of Patiromer for the Treatment of Hyperkalaemia in Patients with Chronic Kidney Disease with and without Heart Failure in Ireland.PharmacoEconomics - open · 2022Article
- A quantitative systems pharmacology model of plasma potassium regulation by the kidney and aldosterone.Journal of pharmacokinetics and pharmacodynamics · 2022Article
- The "FIFTY SHADOWS" of the RALES Trial: Lessons about the Potential Risk of Dietary Potassium Supplementation in Patients with Chronic Kidney Disease.Journal of clinical medicine · 2022Review
- How common is hyperkalaemia? A systematic review and meta-analysis of the prevalence and incidence of hyperkalaemia reported in observational studies.Clinical kidney journal · 2022Article
- Development and validation of a novel nomogram to predict overall survival of patients with moderate to severe chronic kidney disease.Renal failure · 2022Article
- Patterns of chronic and transient hyperkalaemia and clinically important outcomes in patients with chronic kidney disease.Clinical kidney journal · 2022Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSmall-scale studies suggest that hyperkalaemia is a less threatening condition in chronic kidney disease (CKD), arguing adaptation/tolerance to potassium (K+) retention. This study formally evaluates this hypothesis by estimating the distribution of plasma K+ and its association with mortality across CKD stages.
methodsThis observational study included all patients undergoing plasma K+ testing in Stockholm during 2006-11. We randomly selected one K+ measurement per patient and constructed a cross-sectional cohort with mortality follow-up. Covariates included demographics, comorbidities, medications and estimated glomerular filtration rate (eGFR). We estimated K+ distribution and defined K+ ranges associated with 90-, 180- and 365-day mortality.
resultsIncluded were 831 760 participants, of which 70 403 (8.5%) had CKD G3 (eGFR <60-30 mL/min) and 8594 (1.1%) had CKD G4-G5 (eGFR <30 mL/min). About 66 317 deaths occurred within a year. Adjusted plasma K+ increased across worse CKD stages: from median 3.98 (95% confidence interval 3.49-4.59) for eGFR >90 to 4.43 (3.22-5.65) mmol/L for eGFR ≤15 mL/min/1.73 m2. The association between K+ and mortality was U-shaped, but it flattened at lower eGFR strata and shifted upwards. For instance, the range where the 90-day mortality risk increased by no more than 100% was 3.45-4.94 mmol/L in eGFR >60 mL/min, but was 3.36-5.18 in G3 and 3.26-5.53 mmol/L in G4-G5. In conclusion, CKD stage modifies K+ distribution and the ranges that predict mortality in the community.
conclusionAlthough this study supports the view that hyperkalaemia is better tolerated with worse CKD, it challenges the current use of a single optimal K+ range for all patients.
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