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      Dialysate Potassium, Serum Potassium, Mortality, and Arrhythmia Events in Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS)

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          Abstract

          <div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d4085671e283">Background</h5> <p id="P1">Sudden death is a leading cause of death in patients on maintenance hemodialysis (HD). During HD sessions, the gradient between serum and dialysate levels results in rapid electrolytes shifts, which may contribute to arrhythmias and sudden death. Controversies exist on the optimal electrolyte concentration in the dialysate; specifically, it is unclear whether patient outcomes differ among those treated with dialysate potassium (DK) concentration of 3 mEq/L compared to 2 mEq/L. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d4085671e288">Study Design</h5> <p id="P2">Prospective cohort study</p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d4085671e293">Setting &amp; Participants</h5> <p id="P3">55,183 patients from 20 countries in the Dialysis Outcomes and Practice Patterns Study phases 1–5 (1996–2015). </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d4085671e298">Predictor</h5> <p id="P4">DK at study entry.</p> </div><div class="section"> <a class="named-anchor" id="S5"> <!-- named anchor --> </a> <h5 class="section-title" id="d4085671e303">Outcomes</h5> <p id="P5">Cox regression was used to estimate the association between DK and both all-cause mortality and an arrhythmia composite outcome (arrhythmia-related hospitalization or sudden death), adjusting for potential confounders. </p> </div><div class="section"> <a class="named-anchor" id="S6"> <!-- named anchor --> </a> <h5 class="section-title" id="d4085671e308">Results</h5> <p id="P6">During a median follow-up of 16.5 months, 24% of patients died and 7% had an arrhythmia composite outcome. No meaningful difference in clinical outcomes were observed for patients treated with DK 3 <i>vs.</i> 2 mEq/L; the adjusted hazard ratio (95% CI) was 0.96 (0.91, 1.01) for mortality and 0.98 (0.88, 1.08) for the arrhythmia composite. Results were similar across pre-dialysis serum potassium (SK) levels. As in prior studies, higher SK was associated with adverse outcomes. However, DK only had minimal impact on SK measured pre-dialysis (+0.09 mEq/L SK per 1 mEq/L DK; 95% CI: 0.05, 0.14). </p> </div><div class="section"> <a class="named-anchor" id="S7"> <!-- named anchor --> </a> <h5 class="section-title" id="d4085671e316">Limitations</h5> <p id="P7">Data were not available on delivered (vs. prescribed) DK and post-dialysis SK; possible unmeasured confounding. </p> </div><div class="section"> <a class="named-anchor" id="S8"> <!-- named anchor --> </a> <h5 class="section-title" id="d4085671e321">Conclusions</h5> <p id="P8">In combination, these results suggest that approaches other than altering DK concentration (e.g., education on dietary K sources, prescription of K-binding medications) may merit further attention to reduce risks associated with high SK. </p> </div>

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          Author and article information

          Journal
          American Journal of Kidney Diseases
          American Journal of Kidney Diseases
          Elsevier BV
          02726386
          February 2017
          February 2017
          : 69
          : 2
          : 266-277
          Article
          10.1053/j.ajkd.2016.09.015
          5520979
          27866964
          178c2f8d-f28a-430d-b681-12c57ca9568d
          © 2017

          http://www.elsevier.com/tdm/userlicense/1.0/

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