Urinary Potassium Excretion and Progression of CKD
Urinary Potassium Excretion and Progression of CKD
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DOI：
10.2215/cjn.07820618
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发表时间：
2019-03-07
影响因子：
9.8
通讯作者：
Han, Seung Hyeok
中科院分区：
文献类型：
--
作者：
Kim, Hyung Woo;Park, Jung Tak;Han, Seung Hyeok
背景和目的关于尿钾排泄量低或高是否与肾脏预后不良相关的数据一直存在争议。本研究的目的是澄清尿钾排泄和CKD progression.Design，设置，参与者和测量之间的关联我们调查了较低的尿钾排泄和CKD进展之间的关系，并比较了1821例韩国CKD患者队列研究结果的三个尿钾指数。尿钾排泄量采用点尿钾/肌酐比值、点尿钾浓度和24小时尿钾排泄量测定。根据每个尿钾排泄指标的四分位数将患者分为四组。研究终点为eGFR较基线值下降>= 50%和ESKD.Results的复合终点，在5326人年的随访中，392例（22%）患者发生了主要结局。在多变量病因特异性风险模型中，比较最低四分位数和最高四分位数，较低的尿钾/肌酐比值与较高的CKD进展风险相关（校正风险比，1.47; 95%置信区间，1.01 - 2.12）。对其他钾指标的敏感性分析也显示了855例完成24小时尿液采集的患者的一致结果：最低四分位数与最高四分位数的校正风险比为3.05（95%置信区间，1.54至6.04）24小时尿钾排泄量，1.95（95%置信区间，1.05至3.62），点尿钾/肌酐比值为3.79（95%可信区间为1.51 ~ 9.51）。结论低尿钾排泄与CKD的进展有关。
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 potassium excretion and CKD progression and compared three urinary potassium indices among 1821 patients 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 potassium excretion. Patients were 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.