Biomarkers · Electrolytes & Minerals
Serum Potassium
Both low and high values go with higher risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 11% higher risk of death. Risk rises at both ends: not comparable
Serum Potassium and risk of death
Published curve higher than the NHANES fitNHANES fit higher
Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.
Serum Potassium by age and sex
Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.
The percentiles as a table
| Sex | Age | 5th | 25th | Median | 75th | 95th | n | Cycle / source |
|---|---|---|---|---|---|---|---|---|
| All | 20-39 | 3.60 | 3.80 | 4.00 | 4.30 | 4.60 | 1,431 | NHANES 2017-2018 |
| All | 40-59 | 3.60 | 3.90 | 4.10 | 4.30 | 4.62 | 1,547 | NHANES 2017-2018 |
| All | 60+ | 3.50 | 3.90 | 4.10 | 4.40 | 4.90 | 1,889 | NHANES 2017-2018 |
| All | all | 3.60 | 3.90 | 4.10 | 4.30 | 4.70 | 4,867 | NHANES 2017-2018 |
| Men | 20-39 | 3.60 | 3.90 | 4.10 | 4.30 | 4.60 | 684 | NHANES 2017-2018 |
| Men | 40-59 | 3.60 | 3.90 | 4.10 | 4.40 | 4.70 | 722 | NHANES 2017-2018 |
| Men | 60+ | 3.60 | 4.00 | 4.20 | 4.50 | 5.00 | 957 | NHANES 2017-2018 |
| Men | all | 3.60 | 3.90 | 4.10 | 4.40 | 4.80 | 2,363 | NHANES 2017-2018 |
| Women | 20-39 | 3.50 | 3.80 | 4.00 | 4.20 | 4.50 | 747 | NHANES 2017-2018 |
| Women | 40-59 | 3.50 | 3.80 | 4.00 | 4.20 | 4.60 | 825 | NHANES 2017-2018 |
| Women | 60+ | 3.50 | 3.90 | 4.10 | 4.40 | 4.80 | 932 | NHANES 2017-2018 |
| Women | all | 3.50 | 3.80 | 4.00 | 4.30 | 4.60 | 2,504 | NHANES 2017-2018 |
What studies found when this marker was changed
They describe what happened in those study groups, not a recommendation. See all catalogued interventions.
Measured changes in Serum Potassium, study by study
4 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Study results in the groups studied, not predictions for a person.
| Type | Intervention | Reported effect | Evidence | Source |
|---|---|---|---|---|
| diet | Increased potassium intake (oral potassium supplementation) | Oral potassium supplementation (22 to 140 mmol/day) raised circulating potassium by 0.14 mmol/L (95% CI 0.09 to 0.19) with no change in creatinine | meta-analysis | Cappuccio FP, et al. Systematic review and meta-analysis of randomised… |
| pharmacologic | Non-absorbed potassium binder patiromer in CKD with hyperkalemia on RAAS inhibitors | Mean change in serum potassium -1.01 mmol per liter after 4 weeks of patiromer; recurrent hyperkalemia 15% vs 60% with placebo | RCT | Weir MR, et al. N Engl J Med. 2015;372:211-221. |
| pharmacologic | Sodium zirconium cyclosilicate 10 g (up to three doses over 10 h) added to insulin and glucose in emergency department patients with potassium >=5.8 mmol/L | Serum K+ fell 0.72 vs 0.36 mmol/L with placebo at 2 h (LSM difference -0.35 mmol/L, 95% CI -0.68 to -0.02); at 4 h difference -0.13 (NS) | RCT | Peacock WF, Rafique Z, Vishnevskiy K, et al. Emergency Potassium Normalization… |
Things that worsen it
| Type | Condition or exposure | Reported effect | Evidence | Source |
|---|---|---|---|---|
| pharmacologic | Combined ACE inhibitor + ARB (lisinopril + losartan) in diabetic nephropathy | Hyperkalemia 6.3 vs 2.6 events per 100 person-years with combination vs monotherapy | RCT | Fried LF, et al. N Engl J Med. 2013;369:1892-1903. |
| pharmacologic | Loop diuretics (furosemide) without potassium replacement | Hypokalemia (potassium≤3.0mmol/L) more common with furosemide 20 to 40mg/d than fluid restriction alone | RCT | Krisanapan P, et al. Efficacy of Furosemide, Oral Sodium Chloride, and Fluid… |
Sources
- Risk curve: Kovesdy CP 2018 (PMID 29554312): all-cause HR 1.49 at 3.0 and 1.22 at 5.5 vs 4.2. Quadratic fitted exactly through both published points (nadir 4.456); points are exact potassium values (3.0 and 5.5 vs 4.2 mmol/L). Reference: NHANES median 4.1.
- Kovesdy CP, et al. Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis. Eur Heart J. 2018;39:1535-1542.
- Liu et al. Association of Serum Potassium Levels with Mortality and Cardiovascular Events: Findings from the Chinese Multi-provincial Cohort Study. Journal of general internal medicine. 2022;37:2446-2453.
- NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.
Map Serum Potassium against another biomarker.
Related markers: Albumin-Adjusted Anion Gap · Blood Lead · Serum Bicarbonate · Serum Calcium · Serum Chloride · Serum Magnesium · Serum Phosphate · Serum Selenium