Format

Send to

Choose Destination
Nephrol Dial Transplant. 2018 Jul 1;33(7):1207-1214. doi: 10.1093/ndt/gfx241.

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

Author information

1
Healthcare Analytics and Insights, DaVita Clinical Research, Minneapolis, MN, USA.
2
Relypsa Inc, Redwood City, CA, USA.
3
Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA.
4
Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
5
Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

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.

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center