title: The Relation of Serum Potassium Concentration with Cardiovascular Events and Mortality in Community-Living Individuals.
abstract: Hyperkalemia is associated with adverse outcomes in patients with CKD and in hospitalized patients with acute medical conditions. Little is known regarding hyperkalemia, cardiovascular disease (CVD), and mortality in community-living populations. In a pooled analysis of two large observational cohorts, we investigated associations between serum potassium concentrations and CVD events and mortality, and whether potassium-altering medications and eGFR<60 ml/min per 1.73 m2modified these associations.
  
  
  
  Among 9651 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Cardiovascular Health Study (CHS), who were free of CVD at baseline (2000-2002 in the MESA and 1989-1993 in the CHS), we investigated associations between serum potassium categories (<3.5, 3.5-3.9, 4.0-4.4, 4.5-4.9, and ≥5.0 mEq/L) and CVD events, mortality, and mortality subtypes (CVD versus non-CVD) using Cox proportional hazards models, adjusting for demographics, time-varying eGFR, traditional CVD risk factors, and use of potassium-altering medications.
  
  
  
  Compared with serum potassium concentrations between 4.0 and 4.4 mEq/L, those with concentrations ≥5.0 mEq/L were at higher risk for all-cause mortality (hazard ratio, 1.41; 95% confidence interval, 1.12 to 1.76), CVD death (hazard ratio, 1.50; 95% confidence interval, 1.00 to 2.26), and non-CVD death (hazard ratio, 1.40; 95% confidence interval, 1.07 to 1.83) in fully adjusted models. Associations of serum potassium with these end points differed among diuretic users (Pinteraction<0.02 for all), such that participants who had serum potassium ≥5.0 mEq/L and were concurrently using diuretics were at higher risk of each end point compared with those not using diuretics.
  
  
  
  Serum potassium concentration ≥5.0 mEq/L was associated with all-cause mortality, CVD death, and non-CVD death in community-living individuals; associations were stronger in diuretic users. Whether maintenance of potassium within the normal range may improve clinical outcomes requires future study.
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material .
authors.forename: Jan M
authors.initials: JM
authors.lastname: Hughes-Austin
authors.forename: Dena E
authors.initials: DE
authors.lastname: Rifkin
authors.forename: Tomasz
authors.initials: T
authors.lastname: Beben
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Hoofnagle
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.forename: Nona
authors.initials: N
authors.lastname: Sotoodehnia
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Joachim H
authors.initials: JH
authors.lastname: Ix
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D002423:Cause of Death; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006947:Hyperkalemia / Q000097:blood* / Q000401:mortality*; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D011188:Potassium / Q000097:blood*; D014481:United States / Q000453:epidemiology
chemical_list: D004232:Diuretics; D011188:Potassium
keywords: Atherosclerosis; Cardiovascular Diseases; Demography; Epidemiology and outcomes; Ethnic Groups; Humans; Hyperkalemia; Potassium; Proportional Hazards Models; Reference Values; Renal Insufficiency, Chronic; diuretics; glomerular filtration rate; mortality risk; risk factors; serum potassium