Kidney Week 2014: Potassium Levels and Mortality in Patients with CKD
Potassium level abnormalities are common in patients with CKD yet the association between potassium levels and mortality has not been described. I believe this is a novel and well conducted study presented in the poster session on Thursday. Almost 100, 000 CKD stages 3-5 (pre dialysis) were included in the study lead by Dr Allan Collins. Resarchers found that potassium levels below 4.1 mEq/L and above 5 mEq/L were associated with higher mortality rates and many of these subjects were within “normal” potassium range (3.7-5.2 mEq/L). In addition authors calculated the number needed to treat in order to prevent one death (comparing potassium of 5.5 to 4.4 mEq/ L) was only 21. The mortality trend with respect to potassium levels was higher as CKD advanced. Whether treatment to target more narrow potassium levels may have an impact on outcomes in CKD patients remains unknown but clearly opens the opportunity for future interventional trials.
Post by Dr. Magdalena Madero, eAJKD Contributor.
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Reminds me of early studies on anemia treatment in dialysis: sicker patients deviate more from normal – but no proof that making Hb higher or K lower is helpful. The strategy is to:
(1) Demonize K levels of above 5. Really they have no data that they number needed to treat to prevent a death in anything because they didn’t present any data on treatment!
(2) Keep Kayexalate on the market until the new K lowering drugs are approved – based solely on the fact that they lower K.
(3) Once the new drugs are approved – lobby the FDA to ban Kayexalate because of intestinal necrosis.
(4) Then formulate all these guidelines whereby one has to lower K – and use these new drugs since there will be few alternatives. (I’d go with Lasix plus Florinef but I’m sure the dug company speakers will go on about how these drugs are harmful to the heart.)
(5) So there will be lots of pressure to use these new drugs – though there will not be any data to show any true clinical benefit other than lowering a number.
(6) After they’ve been approved for some time, studies will show they’re not actually all that helpful -or indeed harmful.
This seems to be a pattern in nephrology….