Abstract P537: Abnormal Serum Potassium is Associated With Risk of Cardiovascular Disease in Patients With Chronic Kidney Disease

Introduction: Patients with chronic kidney disease (CKD) are at an increased risk of cardiovascular disease (CVD) compared to the general population. The role that abnormal serum potassium plays in the risk of CVD in patients with CKD is unclear. Our objective is to examine the association of hypokalemia and hyperkalemia with risk for cardiovascular events in patients with CKD. Methods: Data from 3,939 patients from the Chronic Renal Insufficiency Cohort (CRIC) Study, a multicenter cohort study of patients with CKD, were used. Cumulative average serum potassium collected annually prior to CVD events was calculated. Hypokalemia (<3.5 mmol/L) and hypokalemia (>5.0 mmol/L) were compared to normokalemia (3.5 - 5.0 mmol/L). Composite CVD was defined as congestive heart failure (CHF), stroke, myocardial infarction (MI), and atrial fibrillation (afib). Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) and were adjusted for age, gender, race/ethnicity, education, study site, body mass index, cigarette smoking, alcohol use, physical activity, history of diabetes, hypercholesteremia, and CVD, baseline use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, use of diuretics, use of other antihypertensive medication, and baseline eGFR. Results: Participants had a median age of 59.0 years and were 55% male, 42% Non-Hispanic White, and 42% Non-Hispanic Black. The prevalence of hypokalemia and hyperkalemia was 2.5% and 6.4%, respectively. Median follow-up was 9.2 years for composite CVD. Hypokalemia and hyperkalemia are both significantly associated with composite CVD, CHF, MI, and afib when compared to normokalemia (Table). Conclusions: We found significant associations between abnormal serum potassium and CVD in patients with CKD. Interventions to maintain normokalemia in patients with CKD could potentially reduce the risk of CVD in this high-risk population.