Postdialysis Hypokalemia and All-Cause Mortality in Patients Undergoing Maintenance Hemodialysis

被引:33
作者
Ohnishi, Tsuyoshi [1 ,3 ,4 ]
Kimachi, Miho [1 ]
Fukuma, Shingo [2 ]
Akizawa, Tadao [5 ]
Fukuhara, Shunichi [1 ,3 ]
机构
[1] Kyoto Univ, Grad Sch Med, Sch Publ Hlth, Dept Healthcare Epidemiol,Sakyo Ku, Kyoto, Japan
[2] Kyoto Univ, Grad Sch Med, Human Hlth Sci, Sakyo Ku, 53 Shogoin Kawahara, Kyoto 6068507, Japan
[3] Fukushima Med Univ, Ctr Innovat Res Commun & Clin Excellence, Fukushima, Fukushima, Japan
[4] Inst Hlth Outcomes & Proc Evaluat Res iHope Int, Nakagyo Ku, Kyoto, Japan
[5] Showa Univ, Sch Med, Div Nephrol, Tokyo, Japan
来源
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2019年 / 14卷 / 06期
关键词
DIALYSIS OUTCOMES; PRACTICE PATTERNS; SERUM POTASSIUM; CARDIAC-ARREST; SUDDEN-DEATH; GUIDELINE; SURVIVAL; REMOVAL;
D O I
10.2215/CJN.07950718
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background and objectives Almost half of patients on dialysis demonstrate a postdialysis serum potassium <= 3.5 mEq/L. We aimed to examine the relationship between postdialysis potassium levels and all-cause mortality. Design, setting, patients, & measurements We conducted a cohort study of 3967 participants on maintenance hemodialysis from the Dialysis Outcomes and Practice Patterns Study in Japan (2009-2012 and 2012-2015). Postdialysis serumpotassiumwasmeasured repeatedly at 4-month intervals and used as a time-varying variable. We estimated the hazard ratio of all-cause mortality rate using Cox hazard regression models, with and without adjusting for time-varying predialysis serum potassium. Models were adjusted for baseline characteristics and time-varying laboratory parameters. We also analyzed associations of combinations of pre-and postdialysis potassium with mortality. Results The age of participants at baseline was 65 +/- 12 years (mean +/- SD), 2552 (64%) were men, and 96% were treatedwith a dialysate potassiumlevel of 2.0 to, 2.5mEq/L. Themedian follow-up periodwas 2.6 (interquartile range, 1.3-2.8) years. During the follow-up period, 562 (14%) of 3967 participants died, and the overallmortality ratewas 6.7 per 100 person-years. Compared with postdialysis potassiumof 3.0 to, 3.5mEq/L, the hazard ratios of postdialysis hypokalemia (, 3.0 mEq/L) were 1.84 (95% confidence interval, 1.44 to 2.34) in the unadjusted model, 1.44 (95% confidence interval, 1.14 to 1.82) in themodelwithout adjusting forpredialysis serumpotassium, and 1.10 (95% confidence interval, 0.84 to 1.44) in the model adjusted for predialysis serum potassium. The combination of pre-and postdialysis hypokalemia was associated with the highest mortality risk (hazard ratio, 1.72; 95% confidence interval, 1.35 to 2.19, reference; pre-and postdialysis nonhypokalemia). Conclusions Postdialysis hypokalemiawas associated withmortality, but this associationwas not independent of predialysis potassium.
引用
收藏
页码:873 / 881
页数:9
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