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Abstract: PO0888

Association of Potassium with Decline in Residual Kidney Function in Incident Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Edward, Jessica A., University of California Irvine, Irvine, California, United States
  • Wenziger, Cachet, University of California Irvine, Irvine, California, United States
  • Hsiung, Jui-Ting, University of California Irvine, Irvine, California, United States
  • Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Streja, Elani, University of California Irvine, Irvine, California, United States
Background

Hyperkalemia has been associated with higher risks for renal decline in non-dialysis kidney disease patients. However, it is unclear whether this relationship exists in hemodialysis (HD) patients.

Methods

A retrospective cohort study was conducted on 6,655 incident HD patients who received treatments from January 2007 to December 2011 and had renal urea clearance (KRU) data in the first and fifth patient quarter (91 day interval) post dialysis initiation. Renal decline was estimated by both KRU difference in the fifth minus first patient quarter as well as by a mixed-effect linear regression to estimate KRU slope over the first year. Baseline potassium levels were stratified into four groups: (≤4.0, > 4.0 to ≤4.5 (reference), > 4.5 to ≤5.0, >5.0 mEq/L) and linear regression models were used to analyze the relationship between potassium and KRU renal decline across models adjusted for demographics (case-mix), malnutrition-inflammation (MICS), and baseline KRU. Mediation analysis was also conducted to analyze if renal decline is a mediator in the association between potassium and mortality.

Results

The median (IQR) of one year difference in KRU was -1.24 (-2.91, 0.12) while the median KRU slope was -1.64 (-2.53, -0.95). Compared to the reference, potassium > 4.5 mEq/L was associated with the greatest difference in KRU in both the case-mix model (-0.28, 95% CI -0.44, -0.11) and in the case-mix + MICS model (-0.20, 95% CI -0.50, -0.06) [Figure 1A]. Similar results were seen for KRU slope [Figure 1B]. It was also observed that KRU slope mediated the relationship between potassium and mortality by 1.78%.

Conclusion

Hyperkalemia shows associations with renal decline over the first year on HD. Future studies should be conducted to investigate the pathways underlying these associations.