High Prevalence of Hyperkalemia and Regional Disparities Among Advanced CKD Patients in Chanthaburi, Thailand: Implications for Clinical Practice

Background: Hyperkalemia is a serious complication in chronic kidney disease (CKD) patients, potentially leading to life-threatening outcomes. While its prevalence is well-documented in Western populations, limited data exist in Thailand, particularly in Chanthaburi Province, an area rich in potassium-containing fruits. Objective: To determine the prevalence and risk factors of hyperkalemia among patients with advanced CKD in Chanthaburi. Materials and Methods: A cross-sectional study was conducted at the CKD clinic of Prapokklao Hospital in Chanthaburi Province, Thailand, between July 2023 and March 2024. Adult CKD patients with an estimated glomerular filtration rate (eGFR) of less than 30 mL/minute/1.73 m² were included, excluding those on dialysis or kidney transplant recipients. Demographic data, comorbidities, laboratory parameters, and medication profiles were recorded. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors associated with hyperkalemia, defined as serum potassium levels of 5 mEq/L or more. Results: From a screening of 1,130 patients in the CKD clinic, 171 were selected for analysis. The average age of the patients was 68.2±15.5 years, with a mean eGFR of 9.4±6.8 mL/minute/1.73 m². The prevalence of hyperkalemia among these patients was 19.9%, with the highest incidence observed in the Lamsing District, where the average serum potassium level was 4.9±0.9 mEq/L. Multivariable analysis identified chronic heart failure and eGFR of less than 8 mL/minute/1.73 m² as significant independent risk factors associated with hyperkalemia. Conclusion: The present study revealed a high prevalence of hyperkalemia in Chanthaburi Province, with significant variability in average serum potassium levels across different regions. This variability emphasized the necessity of prioritizing preventive measures in areas with more pronounced issues. Therefore, particular attention should be directed toward patients with chronic heart failure and an eGFR of less than 8 mL/minute/1.73 m².