Serum and dialysate potassium concentrations and survival in hemodialysis patients

Csaba Kovesdy, Deborah L. Regidor, Rajnish Mehrotra, Jennie Jing, Charles J. McAllister, Sander Greenland, Joel D. Kopple, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

Background and objectives: Controlling serum potassium is an important goal in maintenance hemodialysis patients. We examined the achievement of potassium balance through hemodialysis treatments and the associated fluctuations in serum potassium. Design, setting, participants, & measurements: A 3-yr (July 2001 to June 2004) cohort of 81,013 maintenance hemodialysis patients from all DaVita dialysis clinics across the United States were studied. Nine quarterly-averaged serum potassium groups (<4.0, ≥6.3 mEq/L and seven increments in-between) and four dialysate potassium concentration groups were created in each of the 12 calendar quarters. The death risk associated with predialysis potassium level and dialysate potassium concentration was examined using unadjusted, case-mix adjusted, and malnutrition-inflammation-adjusted time-dependent survival models. Results: Serum potassium correlated with nutritional markers. Serum potassium between 4.6 and 5.3 mEq/L was associated with the greatest survival, whereas potassium <4.0 or ≥5.6 mEq/L was associated with increased mortality. The death risk of serum potassium ≥5.6 mEq/L remained consistent after adjustments. Higher dialysate potassium concentration was associated with increased mortality in hyperkalemic patients with predialysis serum potassium ≥5.0 mEq/L. Conclusions: A predialysis serum potassium of 4.6 to 5.3 mEq/L is associated with the greatest survival in maintenance hemodialysis patients. Hyperkalemic patients who undergo maintenance hemodialysis against lower dialysate bath may have better survival. Limitations of observational studies including confounding by indication should be considered when interpreting these results.

Original languageEnglish (US)
Pages (from-to)999-1007
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume2
Issue number5
DOIs
StatePublished - Sep 1 2007
Externally publishedYes

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Dialysis Solutions
Renal Dialysis
Potassium
Survival
Serum
Maintenance
Social Adjustment
Mortality
Diagnosis-Related Groups
Baths
Malnutrition
Observational Studies
Dialysis

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Kovesdy, C., Regidor, D. L., Mehrotra, R., Jing, J., McAllister, C. J., Greenland, S., ... Kalantar-Zadeh, K. (2007). Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clinical Journal of the American Society of Nephrology, 2(5), 999-1007. https://doi.org/10.2215/CJN.04451206

Serum and dialysate potassium concentrations and survival in hemodialysis patients. / Kovesdy, Csaba; Regidor, Deborah L.; Mehrotra, Rajnish; Jing, Jennie; McAllister, Charles J.; Greenland, Sander; Kopple, Joel D.; Kalantar-Zadeh, Kamyar.

In: Clinical Journal of the American Society of Nephrology, Vol. 2, No. 5, 01.09.2007, p. 999-1007.

Research output: Contribution to journalArticle

Kovesdy, C, Regidor, DL, Mehrotra, R, Jing, J, McAllister, CJ, Greenland, S, Kopple, JD & Kalantar-Zadeh, K 2007, 'Serum and dialysate potassium concentrations and survival in hemodialysis patients', Clinical Journal of the American Society of Nephrology, vol. 2, no. 5, pp. 999-1007. https://doi.org/10.2215/CJN.04451206
Kovesdy, Csaba ; Regidor, Deborah L. ; Mehrotra, Rajnish ; Jing, Jennie ; McAllister, Charles J. ; Greenland, Sander ; Kopple, Joel D. ; Kalantar-Zadeh, Kamyar. / Serum and dialysate potassium concentrations and survival in hemodialysis patients. In: Clinical Journal of the American Society of Nephrology. 2007 ; Vol. 2, No. 5. pp. 999-1007.
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