Supervisors info:
Σμαράγδη Μαρινάκη, Επίκουρη Καθηγήτρια,Ιατρική Σχολή, Ε.Κ.Π.Α.
Παντελεήμων Σαραφίδης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή Α.Π.Θ.
Ιωάννης Μπολέτης, Καθηγητής, Ιατρική Σχολή Ε.Κ.Π.Α.
Summary:
Background & Objectives: Hyperkalaemia is a frequent and potentially life-threatening condition in patients with CKD. Even after successful kidney transplantation, kidney transplant recipients have mild to severe CKD. Moreover, they share co-morbid conditions and frequently use medications that predispose to hyperkalaemia. This study aimed to examine the prevalence and factors associated with hyperkalaemia in this population.
Design & Setting: Over a pre-specified period of 6 months (September 1st 2019 to March 31st 2020), we recorded in a cross-sectional fashion information on serum potassium and relevant demographics, co-morbidities, medications, laboratory and transplant associated variables in clinically stable kidney transplant recipients attending the Transplant Outpatient Clinic of our Department. Hyperkalaemia was classified as follows: serum potassium level >5 mEq/L or >5 with concomitant use of sodium polystyrene sulfonate; ≥5.2; and ≥5.5 mEq/L. Univariate and multiple logistic regression analyses were used to identify factors associated with increased serum potassium >5.0 mEq/L.
Results: The study population consisted of 582 stable kidney transplant recipients, 369 (63.4%) males, aged 52.4±13.5 years, with eGFR of 55.8±20.1 ml/min/1.73m2 transplanted for more than one year. The prevalence of hyperkalaemia defined as potassium >5, >5 and use of sodium polystyrene sulfonate, ≥ 5.2 or ≥5.5, was 22.7%, 22.7%, 14.4% and 4.1% (132, 132, 84 and 24 patients), respectively. In multivariate analysis, male gender (OR 2.020, 95% CI 1.264-3.227) and use of renin-angiotensin-aldosterone-system blockers (OR 1.628, 95% CI 1.045-2.536), were independently associated with hyperkalaemia, while higher eGFR (OR 0.967, 95% CI 0.955-0.979) and diuretic use (OR 0.140, 95% CI 0.046-0.430) were associated with lower odds of the disorder.
Conclusions: The prevalence of mild hyperkalaemia in stable kidney transplant recipients is increased but that of moderate or severe hyperkalemia is relatively low. Male gender and low eGFR are the most potent factors associated with hyperkalaemia. Among a wide range of factors only male gender, RAAS blockade and low eGFR increased the odds of hyperkalemia.
Keywords:
Kidney transplantation, Hyperkalaemia, Glomerular filtration rate renin-angiotensin-aldosterone-system blockers, Diuretics
