Abstract: PO1458
Laxative Use and Plasma Potassium Trajectory 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 longitudinal potassium (K+) balance in advanced CKD.
Methods
In 34,697 US veterans who transitioned to ESRD from 2007-2015 and with ≥2 K+ measurements during the last 1-year period before ESRD transition, we examined the association of time-varying laxative use with change in K+ (slope) over the 1-year pre-ESRD period, using multivariable linear mixed-effects models. The difference in K+ slope by laxative use status was tested by the interaction of laxative use with time for K+ slope in the mixed-effects models.
Results
Overall, the mean age was 68 years; 98% were male; 32% were African American; and 76% were diabetic. In the crude model, there was a significant difference in K+ slope between laxative use and non-use, with declining K+ slope observed only for laxative use (median, -0.010 vs. 0.008 mEq/L/year, P=0.02; Table). Although the magnitude of K+ slopes was clinically negligible, the between-group difference remained significant even after multivariable adjustment, with laxative use being associated with decline in K+ (median, -0.013 vs. 0.003 mEq/L/year, P=0.02; Table).
Conclusion
Laxative use was modestly and independently associated with decline in K+ over the last 1-year pre-ESRD period, suggesting enhanced intestinal potassium excretion by laxatives. Further studies are warranted to test whether active interventions with laxatives can improve potassium management in advanced CKD beyond their traditional indication.
Changes in plasma potassium concentration associated with time-varying laxative use status during the last 1-year pre-ESRD period (n=34,697)
| Change in K+ (median [IQI], mEq/L per year) | P† | ||
| Laxative use | Non-laxative use | ||
| Crude model | -0.010 (-0.21, 0.19) | +0.008 (-0.20, 0.20) | 0.022 |
| Multivariable-adjusted model‡ | -0.013 (-0.19, 0.16) | +0.003 (-0.17, 0.18) | 0.022 |
†P values were for the difference in K+ slope by time-varying laxative use status. ‡Model was adjusted for demographics, smoking status, BMI, comorbidities, length of hospital stay, in-hospital AKI, number of K+ measurements, last K+ value, and time-varying medication use and eGFR
Funding
- NIDDK Support