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Urinary potassium excretion, renal ammoniagenesis, and risk of graft failure and mortality in renal transplant recipients
- Source :
- American Journal of Clinical Nutrition, 104(6), 1703-1711. Oxford University Press, American Journal of Clinical Nutrition, 104(6), 1703. American Society for Nutrition
- Publication Year :
- 2016
- Publisher :
- Oxford University Press, 2016.
-
Abstract
- Renal transplant recipients (RTRs) have commonly been urged to limit their potassium intake during renal insufficiency and may adhere to this principle after transplantation. Importantly, in experimental animal models, low dietary potassium intake induces kidney injury through stimulation of ammoniagenesis. In humans, low potassium intake is an established risk factor for high blood pressure.We hypothesized that low 24-h urinary potassium excretion [UKV; urinary potassium concentration × volume], the gold standard for assessment of dietary potassium intake, represents a risk factor for graft failure and mortality in RTRs. In secondary analyses, we aimed to investigate whether these associations could be explained by ammoniagenesis, plasma potassium, or blood pressure.In a prospective cohort of 705 RTRs, we assessed dietary potassium intake by a single 24-h UKV and food-frequency questionnaires. Cox regression analyses were used to investigate prospective associations with outcome.We included 705 stable RTRs (mean ± SD age: 53 ± 13 y; 57% men) at 5.4 y (IQR: 1.9-12.0 y) after transplantation and 253 kidney donors. Mean ± SD UKV was 73 ± 24 mmol/24 h in RTRs compared with 85 ± 25 mmol/24 h in kidney donors. During follow-up for 3.1 y (IQR: 2.7-3.9 y), 45 RTRs developed graft failure and 83 died. RTRs in the lowest sex-specific tertile of UKV (women,55 mmol/24 h; men,65 mmol/24 h) had an increased risk of graft failure (HR: 3.70; 95% CI: 1.64, 8.34) and risk of mortality (HR; 2.66; 95% CI: 1.53, 4.61), independent of potential confounders. In causal path analyses, 24-h urinary ammonia excretion, plasma potassium, and blood pressure did not affect these associations.Our results indicate that low UKV is associated with a higher risk of graft failure and mortality in RTRs. Specific attention for adequate potassium intake after transplantation seems warranted. This trial was registered at clinicaltrials.gov as NCT02811835.
- Subjects :
- Graft Rejection
Male
Medicine (miscellaneous)
BLOOD-PRESSURE
030204 cardiovascular system & hematology
Kidney
0302 clinical medicine
MARKERS
Risk Factors
Surveys and Questionnaires
030212 general & internal medicine
Prospective Studies
Prospective cohort study
Kidney transplantation
dietary potassium intake
Nutrition and Dietetics
Graft Survival
Middle Aged
C-REACTIVE PROTEIN
medicine.anatomical_structure
Hypertension
SURVIVAL
Female
Adult
medicine.medical_specialty
Urinary system
graft failure
Urology
kidney transplantation
UNITED-STATES
03 medical and health sciences
Ammonia
medicine
INJURY
Humans
CORONARY-HEART-DISEASE
Risk factor
CARDIOVASCULAR EVENTS
Aged
Proportional Hazards Models
urinary potassium excretion
business.industry
ammoniagenesis
Potassium, Dietary
KIDNEY-DISEASE
medicine.disease
mortality
Surgery
Transplantation
SODIUM
Blood pressure
Kidney Failure, Chronic
business
Kidney disease
Follow-Up Studies
Subjects
Details
- Language :
- English
- ISSN :
- 19383207 and 00029165
- Volume :
- 104
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- American Journal of Clinical Nutrition
- Accession number :
- edsair.doi.dedup.....d0565c3a9bf7aa48288ba9057e8ddfe4