Serum-to-dialysate potassium gradient and its association with short-term outcomes in hemodialysis patients

Steven M. Brunelli, David M. Spiegel, Charles Du Mond, Nina Oestreicher, Wolfgang C. Winkelmayer, Csaba Kovesdy

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background. A high serum-to-dialysate potassium (K+) gradient at the start of dialysis leads to rapid lowering of serum K+ and may confer a greater risk of adverse events. Here, we examined the near-term association of K+ gradient with clinical outcomes. Methods. This retrospective (2010-11) event-based study considered 830 741 patient-intervals, each defined by a pre-dialysis measurement of serum K+ made among adult Medicare Parts A and B enrollees who received in-center hemodialysis on a Monday/Wednesday/Friday schedule at a large US dialysis organization. K+ gradient was considered based on the difference in K+ concentration (serum-dialysate) on the date of measurement; analyses accounted for multiple observations per patient. Outcomes considered were: all-cause and cardiovascular hospital admissions, emergency department (ED) visits and deaths. Results. Higher K+ gradient was associated with younger age, greater fistula use, lower comorbidity scores and better nutritional indices. Adjusting for patient differences, there was a dose-response relationship between higher K+ gradient and greater risks of all-cause hospitalization and ED visit. A similar trend was seen for cardiovascular hospitalization but did not achieve statistical significance. No associations were observed with mortality, potentially due to a low number of events. Conclusions. Higher K+ gradient is independently associated with greater risk of all-cause hospitalizations and ED visits. Further research is needed to determine whether interventions that reduce the K+ gradient ameliorate this risk.

Original languageEnglish (US)
Pages (from-to)1207-1214
Number of pages8
JournalNephrology Dialysis Transplantation
Volume33
Issue number7
DOIs
StatePublished - Jul 1 2018

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Dialysis Solutions
Renal Dialysis
Potassium
Hospital Emergency Service
Dialysis
Hospitalization
Serum
Medicare Part A
Medicare Part B
Nutrition Assessment
Fistula
Comorbidity
Appointments and Schedules
Organizations
Mortality
Research

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Serum-to-dialysate potassium gradient and its association with short-term outcomes in hemodialysis patients. / Brunelli, Steven M.; Spiegel, David M.; Du Mond, Charles; Oestreicher, Nina; Winkelmayer, Wolfgang C.; Kovesdy, Csaba.

In: Nephrology Dialysis Transplantation, Vol. 33, No. 7, 01.07.2018, p. 1207-1214.

Research output: Contribution to journalArticle

Brunelli, Steven M. ; Spiegel, David M. ; Du Mond, Charles ; Oestreicher, Nina ; Winkelmayer, Wolfgang C. ; Kovesdy, Csaba. / Serum-to-dialysate potassium gradient and its association with short-term outcomes in hemodialysis patients. In: Nephrology Dialysis Transplantation. 2018 ; Vol. 33, No. 7. pp. 1207-1214.
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