Laxative  use was independently associated with lower risk of hyperkalemia  during the last 1-year pre-ESKD period, finds a recent study.
  The  research is published in the Journal of American Society of  Nephrology.
    Keiichi Sumida and colleagues  from the Division of Nephrology, Department of Medicine, University  of Tennessee Health Science Center, Memphis, Tennessee included a  study population encompassing 36,116 United States veterans  transitioning to ESKD with greater than or equal to one plasma  potassium measurement during the last 1-year period before ESKD  transition.   
    Using generalized estimating  equations with adjustment for potential confounders, the authors  examined the association of time-varying laxative use with risk of  dyskalemia (i.e., hypokalemia [potassium <3.5 mEq/L] or  hyperkalemia [>5.5 mEq/L]) versus normokalemia (3.5–5.5 mEq/L)  over the 1-year pre-ESKD period.   
    To avoid potential overestimation  of dyskalemia risk, potassium measurements within 7 days following a  dyskalemia event were disregarded in the analyses.
    It was observed that over the  last 1-year pre-ESKD period, there were 319,219 repeated potassium  measurements in the cohort. Out of these, 12,787 (4.0%) represented  hypokalemia, and 15,842 (5.0%) represented hyperkalemia; the  time-averaged potassium measurement was 4.5 mEq/L.   
    After multivariable adjustment,  time-varying laxative use (compared with nonuse) was significantly  associated with lower risk of hyperkalemia but was not associated  with risk of hypokalemia. The results were robust to several  sensitivity analyses.
    As a result, the authors  concluded that "laxative use was independently associated with  lower risk of hyperkalemia during the last 1-year pre-ESKD period."
    Our findings support a putative  role of constipation in potassium disarrays and also support (with a  careful consideration for the risk-benefit profiles) the therapeutic  potential of laxatives in hyperkalemia management in advanced CKD,  they authors further inferred.
     https://doi.org/10.1681/ASN.2020081120
 
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