Abstract
Controlling serum potassium is an important goal in maintenance hemodialysis patients. We examined the achievement of potassium balance through hemodialysis treatments and the associated fluctuations in serum potassium. A 3-yr (July 2001 to June 2004) cohort of 81,013 maintenance hemodialysis patients from all DaVita dialysis clinics across the United States were studied. Nine quarterly-averaged serum potassium groups (< 4.0, > or = 6.3 mEq/L and seven increments in-between) and four dialysate potassium concentration groups were created in each of the 12 calendar quarters. The death risk associated with predialysis potassium level and dialysate potassium concentration was examined using unadjusted, case-mix adjusted, and malnutrition-inflammation-adjusted time-dependent survival models. Serum potassium correlated with nutritional markers. Serum potassium between 4.6 and 5.3 mEq/L was associated with the greatest survival, whereas potassium < 4.0 or > or = 5.6 mEq/L was associated with increased mortality. The death risk of serum potassium > or = 5.6 mEq/L remained consistent after adjustments. Higher dialysate potassium concentration was associated with increased mortality in hyperkalemic patients with predialysis serum potassium > or = 5.0 mEq/L. A predialysis serum potassium of 4.6 to 5.3 mEq/L is associated with the greatest survival in maintenance hemodialysis patients. Hyperkalemic patients who undergo maintenance hemodialysis against lower dialysate bath may have better survival. Limitations of observational studies including confounding by indication should be considered when interpreting these results.
Highlights
Background and objectivesControlling serum potassium is an important goal in maintenance hemodialysis patients
Higher dialysate potassium concentration was associated with increased mortality in hyperkalemic patients with predialysis serum potassium >5.0 mEq/L
A predialysis serum potassium of 4.6 to 5.3 mEq/L is associated with the greatest survival in maintenance hemodialysis patients
Summary
Database CreationThe database creation has been described previously (8 –10). In summary, the data warehouse of DaVita, Inc., the second largest dialysisISSN: 1555-9041/205–0999Clinical Journal of the American Society of NephrologyClin J Am Soc Nephrol 2: 999-1007, 2007 care provider in the United States with Ͼ600 dialysis facilities and approximately 40,000 patients at any given time across the country (before the acquisition of Gambro dialysis clinics in 2005), includes comprehensive information on virtually all of its patients. The data warehouse of DaVita, Inc., the second largest dialysis. Clinical Journal of the American Society of Nephrology. Clin J Am Soc Nephrol 2: 999-1007, 2007 care provider in the United States with Ͼ600 dialysis facilities and approximately 40,000 patients at any given time across the country (before the acquisition of Gambro dialysis clinics in 2005), includes comprehensive information on virtually all of its patients. A 3-yr cohort (July 1, 2001, through June 30, 2004) of these patients was studied. All repeated measures of every relevant variable for each patient within the any given calendar quarter (13 wk) were averaged to obtain one quarterly mean value for that variable. The study was approved by institutional review committees of Harbor-UCLA and DaVita.
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