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

• DOI: 10.1053/j.ajkd.2016.09.015
• Publication Date: 2016-11-17T22:47:11Z
• Authors: Angelo Karaboyas; Jarcy Zee; Steven M. Brunelli; Len A. Usvyat; Daniel E. Weiner; Franklin W. Maddux; Allen R. Nissenson; Michel Jadoul; Francesco Locatelli; Wolfgang C. Winke...; Friedrich K. Port; Bruce M. Robinson; Francesca Tentori
• Keywords: Nephrology

Sudden death is a leading cause of in patients on maintenance hemodialysis therapy. During sessions, the gradient between serum and dialysate levels results rapid electrolyte shifts, which may contribute to arrhythmias sudden death. Controversies exist about optimal concentration dialysate; specifically, it unclear whether patient outcomes differ among those treated with potassium 3 mEq/L compared 2 mEq/L.Prospective cohort study.55,183 from 20 countries Dialysis Outcomes Practice Patterns Study (DOPPS) phases 1 5 (1996-2015).Dialysate at study entry.Cox regression was used estimate association both all-cause mortality an arrhythmia composite outcome (arrhythmia-related hospitalization or death), adjusting for potential confounders.During median follow-up 16.5 months, 24% died 7% had outcome. No meaningful difference clinical observed versus (adjusted HRs were 0.96 [95% CI, 0.91-1.01] 0.98 0.88-1.08] composite). Results similar across predialysis levels. As prior studies, higher level associated adverse outcomes. However, only minimal impact measured (+0.09 0.05-0.14] per greater concentration).Data not available delivered (vs prescribed) postdialysis level; possible unmeasured confounding.In combination, these suggest that approaches other than altering (eg, education dietary sources prescription potassium-binding medications) merit further attention reduce risks high