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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

Authors

  • 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
Background

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.

Methods

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.

Results

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).

Conclusion

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.

Funding

  • NIDDK Support – This analysis was supported by AstraZeneca. The DOPPS Program is supported by Amgen (since 1996, founding sponsor), Kyowa Hakko Kirin (since 1999 for Japan DOPPS), and Baxter Healthcare Corp. Additional support for specific projects and countries is provided by Akebia Therapeutics, AstraZeneca, European Renal Association-European Dialysis & Transplant Association (ERA-EDTA), Fibrogen, Fresenius Medical Care Asia-Pacific Ltd, Fresenius Medical Care Canada Ltd, German Society of Nephrology (DGfN), Italian Society of Nephrology (SIN), Janssen, Japanese Society for Peritoneal Dialysis (JSPD), Kidney Care UK, MEDICE Arzneimittel Pütter GmbH & Co KG, Otsuka America, Proteon Therapeutics, the Association of German Nephrology Centres, and Vifor Fresenius Medical Care Renal Pharma. Public funding and support is provided for specific DOPPS projects, ancillary studies, or affiliated research projects by National Health & Medical Research Council (NHMRC) in Australia, Belgian Federal Public Service of Public Health in Belgium, Cancer Care Ontario (CCO) through the Ontario Renal Network (ORN) in Canada, French National Institute of Health and Medical Research (INSERM) in France, Thailand Research Foundation (TRF), Chulalongkorn University Matching Fund, King Chulalongkorn Memorial Hospital Matching Fund, and the National Research Council of Thailand (NRCT) in Thailand, National Institute for Health Research (NIHR) via the Comprehensive Clinical Research Network (CCRN), and Kidney Research UK (KRUK) in the United Kingdom, and the Agency for Healthcare Research and Quality (AHRQ) and National Institutes of Health (NIH) in the US. All support is provided without restrictions on publications. All grants are made to Arbor Research Collaborative for Health and not to Mr. Karaboyas directly.