MO834LOWER POST DIALYSIS POTASSIUM AND HIGHER ULTRAFILTRATION RATE ARE INDEPENDENT PREDICTORS OF ALL-CAUSE MORTALITY IN DIALYSIS PATIENTS

Abstract

Abstract Background and Aims Dialysis is a life-saving procedure for the end-stage kidney disease, but mortality in this category of patients is still high. The survival of these patients is much lower compared to the general population. Factors affecting this survival has been studied for years and still continue to be an important part of current studies. While ultrafiltration rate is known to be associated with mortality in prevalent dialysis patients an important predictor of survival is the control of potassium profile. The aim of our study was to assess the hemodynamic and biochemical data, and to identify any significant association between post-dialysis potassium and all-cause mortality. Method This is a prospective study of 308 patients on maintenance dialysis, followed for seven years, ending 2019. All patients are dialysis dependent for ESKD and getting treatment in a single-center. Hypokalemia was defined as a serum potassium level < 3.5 mEq/L and high ultrafiltration rate (UFR) > 13 ml/kg/h. Other hemodynamic and metabolic data were also evaluated The survival rate was analysed by Kaplan-Meier curves and Cox regression analysis. Results A total of 308 patients were enrolled in this study. Mean age was 52 ± 15.6 years; 62.3% of pts were male; BMI 24.7±4.2. Of these, 55 patients (17.9%) died during the follow-up period. Our data showed the presence left ventricular hypertrophy (p=0.010), peripheral artery disease (p<0.0001), diastolic disfunction (p<0.01) and ultrafiltration rate during dialysis >13ml/kg/h (p=0.002) were the most important predictors of mortality. Metabolic abnormalities, low albumin (p<0.0005), hyperphosphatemia (p=0.011), post-dialysis potassium (p=0.037) were significantly associated with higher mortality. Logistic regression analysis of the metabolic data identified post-dialysis potassium (OR 0.242, 95% CI 0.074 – 0.793, p=0.019), and logistic regression analysis of the hemodynamic data identified ultrafiltration ratio (OR 0.149, CI 0.033 – 0.673, p=0.013) as independent predictors of all-cause mortality. Conclusion Lower post dialysis potassium levels and higher ultrafiltration rate are independently associated with higher all-cause and CV mortality in prevalent hemodialysis patients. Therefore the potassium profile and the UFR of the dialysis patients needs close monitoring and optimal control. The individualization of the dialysis prescription is recommended for each patient and it has an important role in preventing the occurrence of complication with immediate and long term effects. Management of dialysis patients should focus especially on reducing the risk of hypokalemia, not only that of hyperkalemia.