title: Serum Potassium, Mortality, and Kidney Outcomes in the Atherosclerosis Risk in Communities Study.
abstract: OBJECTIVE
  To investigate the association between serum potassium, mortality, and kidney outcomes in the general population and whether potassium-altering medications modify these associations.
  
  
  METHODS
  We studied 15,539 adults in the Atherosclerosis Risk in Communities Study. Cox proportional hazard regression was used to investigate the association of serum potassium at baseline (1987-1989), evaluated categorically (hypokalemia, <3.5 mmol/L; normokalemia, ≥3.5 and <5.5 mmol/L; hyperkalemia, ≥5.5 mmol/L) and continuously using linear spline terms (knots at 3.5 and 5.5 mmol/L), with mortality, sudden cardiac death, incident chronic kidney disease, and end-stage renal disease. The end date of follow-up for all outcomes was December 31, 2012. We also evaluated whether classes of potassium-altering medications modified the association between serum potassium and adverse outcomes.
  
  
  RESULTS
  Overall, 413 (2.7%) of the participants had hypokalemia and 321 (2.1%) had hyperkalemia. In a fully adjusted model, hyperkalemia was significantly associated with mortality (hazard ratio, 1.24; 95% CI, 1.04-1.49) but not sudden cardiac death, chronic kidney disease, or end-stage renal disease. Hypokalemia as a categorical variable was not associated with any outcome; however, associations of hypokalemia with all-cause mortality and kidney outcomes were observed among those who were not taking potassium-wasting diuretics (all P for interaction, <.001).
  
  
  CONCLUSIONS
  Higher values of serum potassium were associated with a higher risk of mortality in the general population. Lower levels of potassium were associated with adverse kidney outcomes and mortality among participants not taking potassium-wasting diuretics.
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Yan
authors: Y
authors: Chen
authors: Department of Nephrology, Geisinger Medical Center, Danville, PA.
authors: Alex R
authors: AR
authors: Chang
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Transplant Surgery, Department of Surgery, Johns Hopkins University, Baltimore, MD.
authors: Mara A
authors: MA
authors: McAdams DeMarco
authors: Department of Nephrology, Tufts Medical Center, Boston, MA.
authors: Lesley A
authors: LA
authors: Inker
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Kunihiro
authors: K
authors: Matsushita
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Shoshana H
authors: SH
authors: Ballew
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD.
authors: Josef
authors: J
authors: Coresh
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD. Electronic address: mgrams2@jhmi.edu.
authors: Morgan E
authors: ME
authors: Grams
mesh_terms: D000328:Adult; D000368:Aged; D016757:Death, Sudden, Cardiac; D062865:Diuretics, Potassium Sparing / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006801:Humans; D006947:Hyperkalemia / Q000401:mortality*; D007008:Hypokalemia / Q000401:mortality*; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
chemical_list: D062865:Diuretics, Potassium Sparing; D049993:Sodium Chloride Symporter Inhibitors; D011188:Potassium