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<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.
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<h5 class="section-title" id="d4085671e288">Study Design</h5>
<p id="P2">Prospective cohort study</p>
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<h5 class="section-title" id="d4085671e293">Setting & Participants</h5>
<p id="P3">55,183 patients from 20 countries in the Dialysis Outcomes and Practice
Patterns Study
phases 1–5 (1996–2015).
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<h5 class="section-title" id="d4085671e298">Predictor</h5>
<p id="P4">DK at study entry.</p>
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<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.
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<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).
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<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.
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<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>
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