Abstract: PO1464
Laxative Use and Incidence of Dyskalemia in Patients with Advanced CKD Transitioning to Dialysis
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolyte, and Acid-Base Disorders
- 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Dashputre, Ankur A., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Potukuchi, Praveen Kumar, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Obi, Yoshitsugu, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Molnar, Miklos Zsolt, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Streja, Elani, University of California Irvine, Irvine, California, United States
- Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
- Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background
Intestinal potassium excretion is increased in patients with advanced CKD. This compensatory mechanism may be enhanced by laxative use; however, little is known about the association of laxative use with dyskalemias in advanced CKD.
Methods
In 34,697 US veterans who transitioned to ESRD from 2007-2015 and with ≥2 plasma potassium (K+) measurements during the last 1-year period before ESRD transition, we examined the association of time-varying laxative use with incidence of dyskalemia over the 1-year pre-ESRD period, using generalized estimating equations with adjustment for potential confounders. K+ levels were categorized as <3.5, 3.5-≤5.5 (reference), and >5.5 mEq/L at each K+ measurement and treated as a repeated multinomial outcome.
Results
The mean (SD) age of the cohort was 68 (11) years; 98% were male; 32% were African American; and 76% were diabetic. In the crude model, laxative use (vs. non-use) was significantly associated with higher risk of hypokalemia (OR [95% CI], 1.19 [1.13-12.5]) and lower risk of hyperkalemia (0.74 [0.71-0.78]) (Table). The associations of laxative use with dyskalemias remained statistically significant even after multivariable adjustment (adjusted ORs [95% CI] for hypo- and hyperkalemia, 1.08 [1.02-1.13] and 0.79 [0.76-0.83], respectively; Table).
Conclusion
Laxative use was independently associated with higher and lower risk of hypo- and hyperkalemia, respectively, during the last 1-year pre-ESRD period. Our findings suggest the putative role of constipation in potassium disarrays and the need for careful consideration for the risk-benefit profiles of laxatives in potassium management in advanced CKD.
Adjusted odds ratios (95% CI) for dyskalemia associated with time-varying laxative use (vs. non-use) during the last 1-year pre-ESRD period (n=34,697)
| Time-varying plasma potassium concentration (mEq/L) | |||
| <3.5 (hypokalemia) | 3.5 to ≤5.5 (normokalemia) | >5.5 (hyperkalemia) | |
| % of all repeated values | 5.9% | 88.6% | 5.5% |
| Crude model | 1.19 (1.13-12.5) | 1 [reference] | 0.74 (0.71-0.78) |
| Multivariable-adjusted model† | 1.08 (1.02-1.13) | 1 [reference] | 0.79 (0.76-0.83) |
†Model was adjusted for demographics, smoking status, BMI, comorbidities, length of hospital stay, in-hospital AKI, number of outpatient medical visits, and time-varying medication use and eGFR
Funding
- NIDDK Support