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Abstract: TH-PO270

Clinical Burden and Management of Hyperkalemia in Hemodialysis Centers in China: A Multicenter Retrospective Study (Visualize-HD)

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Zhao, Xinju, Peking University People's Hospital, Beijing, China
  • Zuo, Li, Peking University People's Hospital, Beijing, China

Group or Team Name

  • For the Visualize-HD Study Group.

Hyperkalemia (HK) is associated with sudden cardiac death in patients on maintenance hemodialysis (mHD). We aimed to examine HK prevalence, serum potassium (sK) management practices, and mortality data in Chinese HD centers.


Visualize-HD (NCT05020717) was a retrospective survey conducted in 31 Chinese administrative divisions. Patients aged ≥18 years who were on mHD for ≥3 months were eligible. HD centers were grouped as having high or low HK (sK >5.0 mmol/L) prevalence based on median values. Outcomes were analyzed over 3 years. The primary outcome was risk factors associated with HK prevalence. Secondary outcomes included HK prevalence, sK management practices, and risk factors associated with mortality.


A total of 50,983 patients from 231 centers were included. The age groups 18–44, 45–64, 65–74, and ≥75 years accounted for 18.7%, 46.5%, 23.0%, and 11.8% of patients, respectively; 59.2% were male. Most patients had a dialysis vintage of <5 years (62.2%), used 2.0 mmol/L dialysate potassium (91.8%), were on three times weekly dialysis (68.0%), and had a sK test once every three months (53.9%). Over half of the cohort (55.2%) received renin-angiotensin-aldosterone system inhibitors and 7.7% received potassium-binding drugs.

HK occurred in 40.8% of patients; 20.4%, 8.7%, and 3.2% had sK >5.5, >6.0, and >6.5 mmol/L, respectively. Higher HK prevalence was associated with a higher proportion of patients with hyperphosphatemia and lower proportions of elderly patients and those with hypoalbuminemia at the HD center level (all P < 0.05).

The 3-year cumulative mortality rate was 21.3%. Over one-third of deceased patients (36.7%) had HK based on their last sK tests. Centers with high vs low HK prevalence had higher mortalities (all-cause: 21.9% vs 20.7%; cardiovascular: 13.5% vs 11.5%, both P < 0.05).


HK is prevalent in Chinese HD centers and is associated with risk factors. Chinese HD centers with higher HK prevalence had increased mortality rates. Long-term sK control is important for improving survival in patients on mHD. Yet, potassium-binding drugs are underused.


  • Commercial Support – AstraZeneca