Serum Potassium Levels and Its Variability in Incident Peritoneal Dialysis Patients: Associations with Mortality
Qingdong Xu,Fenghua Xu,Li Fan,Liping Xiong,Huiyan Li,Shirong Cao,Xiaoyan Lin,Zhihua Zheng,Xueqing Yu,Haiping Mao +9 more
TLDR
A lower serum potassium level was associated with all-cause and cardiovascular mortality during the first year of follow-up in incident PD patients and higher variability of serum potassium levels conferred an increased risk of death in this population of patients.Abstract:
Background Abnormal serum potassium is associated with an increased risk of mortality in dialysis patients. However, the impacts of serum potassium levels on short- and long-term mortality and association of potassium variability with death in peritoneal dialysis (PD) patients are uncertain. Methods We examined mortality-predictability of serum potassium at baseline and its variability in PD patients treated in our center January 2006 through December 2010 with follow-up through December 2012. The hazard ratios (HRs) were used to assess the relationship between baseline potassium levels and short-term (≤1 year) as well as long-term (>1 year) survival. Variability of serum potassium was defined as the coefficient of variation of serum potassium (CVSP) during the first year of PD. Results A total of 886 incident PD patients were enrolled, with 248 patients (27.9%) presented hypokalemia (serum potassium <3.5 mEq/L). During a median follow-up of 31 months (range: 0.5–81.0 months), adjusted all-cause mortality hazard ratio (HR) and 95% confidence interval (CI) for baseline serum potassium of <3.0, 3.0 to <3.5, 3.5 to <4.0, 4.5 to <5.0, and ≥5.0 mEq/L, compared with 4.0 to <4.5 (reference), were 1.79 (1.02–3.14), 1.15 (0.72–1.86), 1.31 (0.82–2.08), 1.33 (0.71–2.48), 1.28 (0.53–3.10), respectively. The increased risk of lower potassium with mortality was evident during the first year of follow-up, but vanished thereafter. Adjusted all-cause mortality HR for CVSP increments of 7.5% to <12.0%; 12.0% to <16.7% and ≥16.7%, compared with <7.5% (reference), were 1.35 (0.67–2.71), 2.00 (1.05–3.83) and 2.18 (1.18–4.05), respectively. Similar association was found between serum potassium levels and its variability and cardiovascular mortality. Conclusions A lower serum potassium level was associated with all-cause and cardiovascular mortality during the first year of follow-up in incident PD patients. In addition, higher variability of serum potassium levels conferred an increased risk of death in this population.read more
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Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
Catherine M. Clase,Juan Jesus Carrero,David H. Ellison,Morgan E. Grams,Brenda R. Hemmelgarn,Meg Jardine,Meg Jardine,Csaba P. Kovesdy,Csaba P. Kovesdy,Gregory A. Kline,Gregor Lindner,Gregorio T. Obrador,Biff F. Palmer,Michael Cheung,David C. Wheeler,Wolfgang C. Winkelmayer,Roberto Pecoits-Filho,Gloria Ashuntantang,Stephan J. L. Bakker,George L. Bakris,Sunil Bhandari,Emmanuel A. Burdmann,Katrina L. Campbell,David M. Charytan,Deborah J. Clegg,Lilian Cuppari,David Goldsmith,Stein Hallan,Jiang He,Charles A. Herzog,Melanie P. Hoenig,Ewout J. Hoorn,Jens Leipziger,Amanda K. Leonberg-Yoo,Edgar V. Lerma,Jose Ernesto Lopez-Almaraz,Jolanta Malyszko,Johannes F.E. Mann,Matti Marklund,Alicia A. McDonough,Masahiko Nagahama,Sankar D. Navaneethan,Bertram Pitt,Oleh Pochynyuk,Thyago Proença de Moraes,Zubaid Rafique,Bruce M. Robinson,Simon D. Roger,Patrick Rossignol,Adam J. Singer,Andrew Smyth,Manish M. Sood,Michael Walsh,Matthew R. Weir,Charles S. Wingo +54 more
TL;DR: Conference deliberations on potassium homeostasis in health and disease, guidance for evaluation and management of dyskalemias in the context of kidney diseases, and research priorities in each of the above areas are provided.
Journal ArticleDOI
Management of hyperkalaemia in chronic kidney disease
TL;DR: The emergence of new medications that specifically target hyperkalaemia could lead to a therapeutic paradigm shift, emphasizing preventive management over ad hoc treatment of incidentally discovered elevations in serum potassium levels.
Journal ArticleDOI
Management of Hyperkalemia: An Update for the Internist
TL;DR: The emergence of 2 new potassium-binding medications for acute and chronic therapy of hyperkalemia may soon allow the continued use of medications such as renin-angiotensin-aldosterone system inhibitors even in patients who are prone to hyperKalemia.
Journal ArticleDOI
Updates in hyperkalemia: Outcomes and therapeutic strategies.
TL;DR: The development of novel potassium binders has ushered in a new era of hyperKalemia management, with a focus on chronic therapy while maintaining the use of beneficial, but hyperkalemia-inducing medications such as renin-angiotensin aldosterone system inhibitors.
Journal ArticleDOI
Peritoneal dialysis in China: meeting the challenge of chronic kidney failure.
Xueqing Yu,Xiao Yang +1 more
TL;DR: There are more than 40,000 prevalent PD patients in China, representing approximately 20% of the total dialysis population, and recently, a National Dialysis Unit Training Program for countywide hospitals has been initiated.
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