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Kidney Week

Abstract: SA-OR067

Hyperkalemia Excursions and Mortality in Hemodialysis Patients: Results from the DOPPS

Session Information

  • Hemodialysis Potpourri
    November 09, 2019 | Location: 144, Walter E. Washington Convention Center
    Abstract Time: 06:18 PM - 06:30 PM

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • James, Glen, AstraZeneca, Cambridge, United Kingdom
  • Hedman, Katarina, AstraZeneca, Cambridge, United Kingdom
  • Moreno Quinn, Carol Patricia, MedImmune, Cambridge, United Kingdom
  • De Sequera, Patricia, University Hospital Infanta Leonor, Madrid, Spain
  • Weinreich, Thomas, Nephrologisches Zentrum, Villingen Schwenningen, Germany
  • Ni, Zhaohui, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, SHANGHAI, China
  • Alhejaili, Fayez F., King Fahad National Guard Hospital, Riyadh, Saudi Arabia
  • Nitta, Kosaku, Tokyo Women's Medical University, Shinjuku-ku, ToKyo, Japan
  • Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Hyperkalemia (HK) has been associated with adverse clinical events in hemodialysis (HD) patients when analyzing a single potassium (K) measurement or time-averaged K values, but the mean value of serial pre-dialysis K measurements does not reflect variability or excursions out of K target range.


We used data from 21 countries in phases 4-6 (2009-2018) of the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective cohort study. We assessed the number of HK excursions over 4-month periods using 3 definitions – serum K >5.0, >5.5, and >6.0 mEq/L – and investigated the association with all-cause mortality over the subsequent 4 months using Cox regression and adjusted for potential confounders, including hypokalemia (K <4.0) excursions and other markers of malnutrition.


We studied 243,886 4-month periods across 61,897 HD patients; The prevalence of at least 1 HK excursion over a 4-month period was 58%, 30%, and 12%, respectively, for serum K >5.0, >5.5 and >6.0 mEq/L. HK excursions >5.5 were most common in Russia (68%) and least common in the US (25%). Patients with HK excursions tended to be younger, with longer HD vintage and higher serum levels of albumin and phosphorus. Compared to 4-month periods with no HK excursions, adjusted models showed that the mortality rate over the subsequent 4 months was 10-20% higher with exactly 1 HK excursion (even at only >5.0 mEq/L), and 20-30% higher with 2+ HK excursions (Figure).


A clear association between one or more HK excursions and all-cause mortality was observed regardless of the hyperkalemic threshold. This method to assess target K achievement may be more sensitive at identifying patients with greater mortality risk over short-term intervals at lower thresholds (5.1-5.5 mEq/L) than previously reported, prompting reassessment of existing HK severity ranges and exploration of strategies to avoid HK excursions.


  • NIDDK Support