ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

ASN / Education & Meetings / Kidney Week /

Please note that you are viewing an archived section from 2019 and some content may be unavailable. To unlock all content for 2019, please visit the archives.

Abstract: SA-PO879

Plasma Potassium Variability and Associated Post-Transition Mortality in Patients with Advanced CKD Transitioning to ESRD

Session Information

  • CKD: Pharmacoepidemiology
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Dashputre, Ankur A., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Sumida, Keiichi, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kar, Suryatapa, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Obi, Yoshitsugu, University of California Irvine, Irvine, California, United States
  • Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

Both higher and lower plasma potassium (K+) levels are associated with increased mortality, but it is unclear if a propensity for higher plasma K+ variability (i.e. more frequent or extreme deviations in plasma K+) prior to dialysis initiation is associated with post-ESRD adverse outcomes independent of baseline K+ levels.

Methods

In 34,167 US Veterans who transitioned to dialysis between 2007-2014 and had ≥1 plasma K+ measurement in each year over the last three years prior to dialysis initiation, we examined the association of plasma K+ variability (PPv, defined as the standard deviation of intra-individual K+ values over the three-year study period and expressed as quartiles) with all-cause mortality within 6-months after dialysis initiation, using Cox proportional hazard models with adjustment for baseline K+, demographics, comorbidities, cumulative length of hospital stay, medications, and average eGFR and number of K+ measurements (median [IQR]: 19 [8-35]) over the three-year study period.

Results

The mean (SD) age of the cohort was 67 (11) years; 98% were male, 29% were African American, and 77% were diabetic. After adjusting for potential confounders, higher PPv quartiles were consistently associated with increased risk of all-cause mortality within 6 months of dialysis initiation (adjusted HRs [95% CI] for quartiles 2-4 [vs. quartile 1], 1.09 [1.01-1.18], 1.12 [1.03-1.22], and 1.19 [1.09-1.30] in model 5; Figure)

Conclusion

Greater pre-ESRD PPv is associated with higher all-cause mortality within 6 months of dialysis initiation. Clinical trials are needed to determine if measures used to stabilize plasma K+ can improve patient outcomes.

Funding

  • NIDDK Support