Dialysate Potassium and Mortality in a Prospective Hemodialysis Cohort

Antoney Ferrey, Amy S. You, Csaba Kovesdy, Tracy Nakata, Mary Veliz, Danh V. Nguyen, Kamyar Kalantar-Zadeh, Connie M. Rhee

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)415-423
Number of pages9
JournalAmerican Journal of Nephrology
Volume47
Issue number6
DOIs
StatePublished - Jul 1 2018

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Dialysis Solutions
Renal Dialysis
Potassium
Mortality
Serum
Dialysis
Diagnosis-Related Groups
Kidney Diseases
Proportional Hazards Models
Malnutrition

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Ferrey, A., You, A. S., Kovesdy, C., Nakata, T., Veliz, M., Nguyen, D. V., ... Rhee, C. M. (2018). Dialysate Potassium and Mortality in a Prospective Hemodialysis Cohort. American Journal of Nephrology, 47(6), 415-423. https://doi.org/10.1159/000489961

Dialysate Potassium and Mortality in a Prospective Hemodialysis Cohort. / Ferrey, Antoney; You, Amy S.; Kovesdy, Csaba; Nakata, Tracy; Veliz, Mary; Nguyen, Danh V.; Kalantar-Zadeh, Kamyar; Rhee, Connie M.

In: American Journal of Nephrology, Vol. 47, No. 6, 01.07.2018, p. 415-423.

Research output: Contribution to journalArticle

Ferrey, A, You, AS, Kovesdy, C, Nakata, T, Veliz, M, Nguyen, DV, Kalantar-Zadeh, K & Rhee, CM 2018, 'Dialysate Potassium and Mortality in a Prospective Hemodialysis Cohort', American Journal of Nephrology, vol. 47, no. 6, pp. 415-423. https://doi.org/10.1159/000489961
Ferrey, Antoney ; You, Amy S. ; Kovesdy, Csaba ; Nakata, Tracy ; Veliz, Mary ; Nguyen, Danh V. ; Kalantar-Zadeh, Kamyar ; Rhee, Connie M. / Dialysate Potassium and Mortality in a Prospective Hemodialysis Cohort. In: American Journal of Nephrology. 2018 ; Vol. 47, No. 6. pp. 415-423.
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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.",
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AU - Nakata, Tracy

AU - Veliz, Mary

AU - Nguyen, Danh V.

AU - Kalantar-Zadeh, Kamyar

AU - Rhee, Connie M.

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