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Abstract: PO1140

Dietary Potassium Intake and All-Cause Mortality in Adults Undergoing Hemodialysis: The DIET-HD Cohort Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Bernier-Jean, Amelie, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  • Wong, Germaine, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  • Saglimbene, Valeria Maria, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  • Ruospo, Marinella, Diaverum Renal Services Group, Lund, Scania, Sweden
  • Palmer, Suetonia, Department of Medicine, University of Otago, Dunedin, New Zealand
  • Garcia-Larsen, Vanessa, Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Natale, Patrizia, Diaverum Renal Services Group, Lund, Sweden
  • Johnson, David W., Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia, Brisbane, Queensland, Australia
  • Tonelli, Marcello, University of Calgary, Calgary, Canada, Calgary, Alberta, Canada
  • Hegbrant, Jorgen BA, Diaverum Renal Services Group, Lund, Sweden
  • Craig, Jonathan C., College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
  • Teixeira-Pinto, Armando, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  • Strippoli, Giovanni F.M., School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
Background

Dietary modification to reduce the risk of hyperkalemia in people undergoing maintenance hemodialysis is standard practice and is commonly recommended in guidelines despite a lack of evidence. A low potassium diet may impair quality of life and nutritional status. We aimed to assess the association between dietary potassium intake and mortality and whether hyperkalemia mediates this association.

Methods

9690 adults undergoing maintenance hemodialysis in Europe and South America were recruited in the DIET-HD study, of which 1647 were excluded for lack of data-linkage identifier or incomplete or implausible dietary assessment. We measured baseline potassium intake from the GA2LEN food frequency questionnaire and performed time-to-event and mediation analyses.

Results

The median dietary potassium intake at baseline was 3.5 g/day (IQR 2.5 to 5.0). During a median follow-up of 3.97 years (25,890 person-years), we observed 2921 (36%) deaths including 1316 (45%) from cardiovascular causes. After adjusting for baseline characteristics including presence of cardiac disease and food groups, dietary potassium intake was not associated with all-cause mortality (hazard ratio [HR] 1.00 95% confidence interval [CI] 0.95 to 1.05). A mediation analysis showed no association of potassium intake with mortality either through or independent of serum potassium (HR 0.999, 95% CI 0.996 to 1.002 and 1.000, 95% CI 0.999 to 1.002, respectively). Higher potassium intake was not associated with higher serum potassium (B=0.04 mEq/L 95% CI 0.00 to 0.09) or the prevalence of hyperkalemia (≥ 6.0mEq/L) at baseline (OR=1.08, 95% CI 0.93 to 1.24). Hyperkalemia was associated with cardiovascular death (HR=1.23 95% CI 1.03 to 1.48).

Conclusion

Higher dietary intake of potassium is not associated with hyperkalemia or death in patients treated with maintenance hemodialysis.

Funding

  • Government Support - Non-U.S.