Antoney Ferrey1, Amy S You1, Csaba P Kovesdy2,3, Tracy Nakata1, Mary Veliz1, Danh V Nguyen4, Kamyar Kalantar-Zadeh1,5, Connie M Rhee1. 1. Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA. 2. Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA. 3. University of Tennessee Health Science Center, Memphis, Tennessee, USA. 4. Department of General Internal Medicine, University of California Irvine School of Medicine, Orange, California, USA. 5. Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA.
Abstract
BACKGROUND: Studies examining the association of dialysate potassium concentration and mortality in hemodialysis patients show conflicting findings. We hypothesized that low dialysate potassium concentrations are associated with higher mortality, particularly in patients with high pre-dialysis serum potassium concentrations. METHODS: We evaluated 624 hemodialysis patients from the prospective Malnutrition, Diet, and Racial Disparities in Kidney Disease study recruited from 16 outpatient dialysis facilities over 2011-2015 who underwent protocolized collection of dialysis treatment characteristics every 6 months. We examined the association of dialysate potassium concentration, categorized as 1, 2, and 3 mEq/L, with all-cause mortality risk in the -overall cohort, and stratified by pre-dialysis serum potassium (< 5 vs. ≥5 mEq/L) using case-mix adjusted Cox models. RESULTS: In baseline analyses, dialysate potassium concentrations of 1 mEq/L were associated with higher mortality, whereas concentrations of 3 mEq/L were associated with similar mortality in the overall cohort (reference: 2 mEq/L): adjusted hazard ratios (aHRs; 95% CI) 1.70 (1.01-2.88) and 0.95 (0.64-1.39), respectively. In analyses stratified by serum potassium, baseline dialysate potassium concentrations of 1 mEq/L were associated with higher mortality in patients with serum potassium ≥5 mEq/L but not in those with serum potassium < 5 mEq/L: aHRs (95% CI) 2.87 (1.51-5.46) and 0.74 (0.27-2.07), respectively (p interaction = 0.04). These findings were robust with incremental adjustment for serum potassium, potassium-binding resins, and potassium-modifying medications. CONCLUSION: Low (1 mEq/L) dialysate potassium -concentrations were associated with higher mortality, particularly in hemodialysis patients with high pre-dialysis serum potassium. Further studies are needed to identify therapeutic strategies that mitigate inter-dialytic serum potassium accumulation and subsequent high dialysate serum potassium gradients in this population.
BACKGROUND: Studies examining the association of dialysate potassium concentration and mortality in hemodialysis patients show conflicting findings. We hypothesized that low dialysate potassium concentrations are associated with higher mortality, particularly in patients with high pre-dialysis serum potassium concentrations. METHODS: We evaluated 624 hemodialysis patients from the prospective Malnutrition, Diet, and Racial Disparities in Kidney Disease study recruited from 16 outpatient dialysis facilities over 2011-2015 who underwent protocolized collection of dialysis treatment characteristics every 6 months. We examined the association of dialysate potassium concentration, categorized as 1, 2, and 3 mEq/L, with all-cause mortality risk in the -overall cohort, and stratified by pre-dialysis serum potassium (< 5 vs. ≥5 mEq/L) using case-mix adjusted Cox models. RESULTS: In baseline analyses, dialysate potassium concentrations of 1 mEq/L were associated with higher mortality, whereas concentrations of 3 mEq/L were associated with similar mortality in the overall cohort (reference: 2 mEq/L): adjusted hazard ratios (aHRs; 95% CI) 1.70 (1.01-2.88) and 0.95 (0.64-1.39), respectively. In analyses stratified by serum potassium, baseline dialysate potassium concentrations of 1 mEq/L were associated with higher mortality in patients with serum potassium ≥5 mEq/L but not in those with serum potassium < 5 mEq/L: aHRs (95% CI) 2.87 (1.51-5.46) and 0.74 (0.27-2.07), respectively (p interaction = 0.04). These findings were robust with incremental adjustment for serum potassium, potassium-binding resins, and potassium-modifying medications. CONCLUSION: Low (1 mEq/L) dialysate potassium -concentrations were associated with higher mortality, particularly in hemodialysis patients with high pre-dialysis serum potassium. Further studies are needed to identify therapeutic strategies that mitigate inter-dialytic serum potassium accumulation and subsequent high dialysate serum potassium gradients in this population.
Authors: Michel Jadoul; Jyothi Thumma; Douglas S Fuller; Francesca Tentori; Yun Li; Hal Morgenstern; David Mendelssohn; Tadashi Tomo; Jean Ethier; Friedrich Port; Bruce M Robinson Journal: Clin J Am Soc Nephrol Date: 2012-03-08 Impact factor: 8.237
Authors: Akos Ujszaszi; Maria E Czira; Katalin Fornadi; Marta Novak; Istvan Mucsi; Miklos Z Molnar Journal: Int Urol Nephrol Date: 2012-01-14 Impact factor: 2.370
Authors: Patrick H Pun; Ruediger W Lehrich; Emily F Honeycutt; Charles A Herzog; John P Middleton Journal: Kidney Int Date: 2010-09-01 Impact factor: 10.612
Authors: Kamyar Kalantar-Zadeh; Joel D Kopple; Michael H Humphreys; Gladys Block Journal: Nephrol Dial Transplant Date: 2004-04-06 Impact factor: 5.992
Authors: John K Leypoldt; Michael A Kraus; Bertrand L Jaber; Eric D Weinhandl; Allan J Collins Journal: BMC Nephrol Date: 2019-07-09 Impact factor: 2.388
Authors: Michelle Da Silva Lodge; Thilini Abeygunaratne; Helen Alderson; Ibrahim Ali; Nina Brown; Constantina Chrysochou; Rosie Donne; Ibi Erekosima; Philip Evans; Emma Flanagan; Simon Gray; Darren Green; Janet Hegarty; Audrey Hyde; Philip A Kalra; Elizabeth Lamerton; David Lewis; Rachel Middleton; David New; Robert Nipah; Donal O'Donoghue; Edmond O'Riordan; Dimitrios Poulikakos; Francesco Rainone; Maharajan Raman; James Ritchie; Smeeta Sinha; Grahame Wood; J Tollitt Journal: BMC Nephrol Date: 2020-12-07 Impact factor: 2.388
Authors: Danai Bem; Daniel Sugrue; Ben Wilding; Ina Zile; Karin Butler; David Booth; Eskinder Tafesse; Phil McEwan Journal: Ren Fail Date: 2021-12 Impact factor: 2.606
Authors: Pierre Delanaye; François Krzesinski; Bernard E Dubois; Alexandre Delcour; Sébastien Robinet; Caroline Piette; Jean-Marie Krzesinski; Patrizio Lancellotti Journal: Clin Kidney J Date: 2019-11-26
Authors: Steven Fishbane; Martin Ford; Masafumi Fukagawa; Kieran McCafferty; Anjay Rastogi; Bruce Spinowitz; Konstantin Staroselskiy; Konstantin Vishnevskiy; Vera Lisovskaja; Ayman Al-Shurbaji; Nicolas Guzman; Sunil Bhandari Journal: BMC Nephrol Date: 2022-02-08 Impact factor: 2.388
Authors: Song In Baeg; Junseok Jeon; Danbee Kang; Soo Jin Na; Juhee Cho; Kyunga Kim; Jeong Hoon Yang; Chi Ryang Chung; Jung Eun Lee; Wooseong Huh; Gee Young Suh; Yoon-Goo Kim; Dae Joong Kim; Hye Ryoun Jang Journal: Front Med (Lausanne) Date: 2022-08-31
Authors: Sara S Kalantar; Amy S You; Keith C Norris; Tracy Nakata; Alejandra Novoa; Kimberly Juarez; Danh V Nguyen; Connie M Rhee Journal: Kidney Med Date: 2019-09-05