Dyskalemias Before Dialysis Increases Risk of Post-Dialysis mortality
Patients with advanced NDD-CKD are prone to plasma potassium (K) variability and dyskalemias(hypo- and hyperkalemia), because of the reduced homeostatic potential of the kidney. In a study, researchers have found that high potassium variability is associated with higher all-cause mortality after dialysis initiation. The research has been published in the Kidney International reports on December 03, 2020.
Both hyperkalemia and hypokalemia are associated with an increased risk of mortality, adverse clinical outcomes, and increased economic burden in patients with NDD-CKD. Although the association of dyskalemias with mortality has been well studied in NDD-CKD, the relationship of plasma K variability with mortality is unclear. Therefore, a research team of America, conducted a study, to assess the association between K variability before dialysis initiation with mortality after dialysis initiation.
Researchers assessed longitudinal data from the Transition of Care in Chronic Kidney Disease, a nationally representative historic cohort of US veterans with incident end-stage renal disease transitioning to dialysis from 1, October 2007 through 31, March 2015. They identified a total of 34,167 US veterans with at least 1 K measurement each year over 3 years before transition (3-year prelude). For each patient, they used a linear mixed-effects model, to regress K over time (in years) over the 3-year prelude to derive K variability. The major outcomes assessed were 6-month all-cause and cardiovascular mortality after dialysis initiation.
They categorized the potassium variability in the following quartiles:
- less than 0.31,
- 0.31 and higher but less than 0.41,
- 0.41 and higher but less than 0.52, and
- 0.52 mEq/L or more.
Upon analysis, they found that higher prelude K variability was associated with higher multivariable-adjusted risk of all-cause mortality, but not cardiovascular mortality (adjusted hazard/sub hazards ratios [95% confidence interval] for highest quartile [vs lowest] of K variability, 1.14 and 0.99 for all-cause and cardiovascular mortality, respectively).
The authors concluded, "a higher K variability before dialysis initiation (especially K variability measured in the last year before dialysis initiation) is associated with an increased risk of mortality in incident dialysis patients. Thus, higher K variability may serve as a clinically important prognostic marker for future clinical events."
For further information:
https://www.kireports.org/article/S2468-0249(20)31778-2/fulltext
