Predialysis Potassium Variability and Postdialysis Mortality in Patients With Advanced CKD

Kidney International Reports

Suryatapa Kar¹  Praveen K. Potukuchi¹  Csaba P. Kovesdy²  Elani Streja³  Kamyar Kalantar-Zadeh⁴  Fridtjof Thomas⁵  Miklos Z. Molnar⁵  Yoshitsugu Obi⁵  Keiichi Sumida⁶  Ankur A. Dashputre⁶ 

[1] Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA;Hypertension, Department of Medicine, University of Utah, Salt Lake City, UT, USA;Division of Biostatistics, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA;;Division of Nephrology &Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA;Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA;

关键词: chronic kidney disease;    dialysis;    end-stage renal disease;    potassium;    survival;   

DOI  :  

来源: DOAJ

【 摘 要 】

Introduction: Patients with advanced non–dialysis-dependent chronic kidney disease (NDD-CKD) are prone to potassium (K) imbalances due to reduced kidney function. Both hypo- and hyperkalemia are associated with increased mortality; however, it is unclear if K variability before dialysis initiation is associated with outcomes after dialysis initiation. Methods: We identified 34,167 US veterans with advanced NDD-CKD transitioning to dialysis between October 1, 2007, through March 31, 2015, who had at least 1 K measurement each year over a 3-year period before transition (3-year prelude). For each patient, a linear mixed-effects model was used to regress K over time (in years) over the 3-year prelude to derive K variability (square root of the average squared distance between the observed and estimated K). The main outcomes of interest were 6-month all-cause and cardiovascular mortality after dialysis initiation. Multivariable Cox and Fine-Gray competing risk regression adjusted for 3-year prelude K intercept, K slope (per year), demographics, smoking status, comorbidities, length of hospitalizations, body mass index, vascular access type, medications, average estimated glomerular filtration rate, and number of K measurements over the 3-year prelude were used to assess the association of K variability (expressed as quartiles) with all-cause and cardiovascular mortality, respectively. Results: Higher prelude K variability was associated with higher multivariable-adjusted risk of all-cause mortality but not cardiovascular mortality (adjusted hazard/subhazard ratios [95% confidence interval] for highest quartile [vs. lowest] of K variability, 1.14 [1.03–1.25] and 0.99 [0.85–1.16] for all-cause and cardiovascular mortality, respectively). Conclusion: Higher K variability is associated with higher all-cause mortality after dialysis initiation.

【 授权许可】

Unknown