Back to Search
Start Over
Serum potassium and mortality risk in hemodialysis patients: a cohort study
- Source :
- KIDNEY MEDICINE, 4(1). ELSEVIER, Kidney Medicine, Kidney medicine, 4(1):100379. Elsevier Inc., Kidney Medicine, 4(1):100379. Elsevier Inc., Netherlands Cooperative Study on the Adequacy of Dialysis-2 (NECOSAD) Study Group 2022, ' Serum Potassium and Mortality Risk in Hemodialysis Patients : A Cohort Study ', Kidney medicine, vol. 4, no. 1, 100379 . https://doi.org/10.1016/j.xkme.2021.08.013
- Publication Year :
- 2022
-
Abstract
- Rationale & Objective Both hypo- and hyperkalemia can cause fatal cardiac arrhythmias. Although predialysis serum potassium level is a known modifiable risk factor for death in patients receiving hemodialysis, especially for hypokalemia, this risk may be underestimated. Therefore, we investigated the relationship between predialysis serum potassium level and death in incident hemodialysis patients and whether there is an optimum level. Study Design Prospective multicenter cohort study. Setting & Participants 1,117 incident hemodialysis patients (aged >18 years) from the Netherlands Cooperative Study on the Adequacy of Dialysis-2 study were included and followed from their first hemodialysis treatment until death, transplantation, switch to peritoneal dialysis, or a maximum of 10 years. Exposure Predialysis serum potassium levels were obtained every 6 months and divided into 6 categories: ≤4.0 mmol/L, >4.0 mmol/L to ≤4.5 mmol/L, >4.5 mmol/L to ≤5.0 mmol/L, >5.0 mmol/L to ≤5.5 mmol/L (reference), >5.5 mmol/L to ≤6.0 mmol/L, and >6.0 mmol/L. Outcomes 6-month all-cause mortality. Analytical Approach Cox proportional hazards and restricted cubic spline analyses with time-dependent predialysis serum potassium levels were used to calculate the adjusted HRs for death. Results At baseline, the mean age of the patients was 63 years (standard deviation, 14 years), 58% were men, 26% smoked, 24% had diabetes, 32% had cardiovascular disease, the mean serum potassium level was 5.0 mmol/L (standard deviation, 0.8 mmol/L), 7% had a low subjective global assessment score, and the median residual kidney function was 3.5 mL/min/1.73 m2 (IQR, 1.4-4.8 mL/min/1.73 m2). During the 10-year follow-up, 555 (50%) deaths were observed. Multivariable adjusted HRs for death according to the 6 potassium categories were as follows: 1.42 (95% CI, 1.01-1.99), 1.09 (95% CI, 0.82-1.45), 1.21 (95% CI, 0.94-1.56), 1 (reference), 0.95 (95% CI, 0.71-1.28), and 1.32 (95% CI, 0.97-1.81). Limitations Shorter intervals between potassium measurements would have allowed for more precise mortality risk estimations. Conclusions We found a U-shaped relationship between serum potassium level and death in incident hemodialysis patients. A low predialysis serum potassium level was associated with a 1.4-fold stronger risk of death than the optimal level of approximately 5.1 mmol/L. These results may imply the cautious use of potassium-lowering therapy and a potassium-restricted diet in patients receiving hemodialysis.<br />Graphical abstract
- Subjects :
- medicine.medical_specialty
Hyperkalemia
medicine.medical_treatment
Population
hemodialysis, hyperkalemia, hypokalemia, mortality, potassium
Peritoneal dialysis
SDG 3 - Good Health and Well-being
Internal medicine
hypokalemia
Internal Medicine
medicine
education
Dialysis
Original Research
education.field_of_study
hemodialysis
business.industry
potassium
Hazard ratio
hyperkalemia
mortality
Hypokalemia
Transplantation
Nephrology
Hemodialysis
medicine.symptom
business
Subjects
Details
- Language :
- English
- ISSN :
- 25900595
- Database :
- OpenAIRE
- Journal :
- KIDNEY MEDICINE, 4(1). ELSEVIER, Kidney Medicine, Kidney medicine, 4(1):100379. Elsevier Inc., Kidney Medicine, 4(1):100379. Elsevier Inc., Netherlands Cooperative Study on the Adequacy of Dialysis-2 (NECOSAD) Study Group 2022, ' Serum Potassium and Mortality Risk in Hemodialysis Patients : A Cohort Study ', Kidney medicine, vol. 4, no. 1, 100379 . https://doi.org/10.1016/j.xkme.2021.08.013
- Accession number :
- edsair.doi.dedup.....f50015a5c090bf27c2e8b3a2ec8f972c