Serum and dialysate potassium concentrations and survival in hemodialysis patients.
OBJECTIVE
Controlling serum potassium is an important goal in maintenance hemodialysis patients. We examined the achievement of potassium balance through hemodialysis treatments and the associated fluctuations in serum potassium.


METHODS
A 3-yr (July 2001 to June 2004) cohort of 81,013 maintenance hemodialysis patients from all DaVita dialysis clinics across the United States were studied. Nine quarterly-averaged serum potassium groups (< 4.0, > or = 6.3 mEq/L and seven increments in-between) and four dialysate potassium concentration groups were created in each of the 12 calendar quarters. The death risk associated with predialysis potassium level and dialysate potassium concentration was examined using unadjusted, case-mix adjusted, and malnutrition-inflammation-adjusted time-dependent survival models.


RESULTS
Serum potassium correlated with nutritional markers. Serum potassium between 4.6 and 5.3 mEq/L was associated with the greatest survival, whereas potassium < 4.0 or > or = 5.6 mEq/L was associated with increased mortality. The death risk of serum potassium > or = 5.6 mEq/L remained consistent after adjustments. Higher dialysate potassium concentration was associated with increased mortality in hyperkalemic patients with predialysis serum potassium > or = 5.0 mEq/L.


CONCLUSIONS
A predialysis serum potassium of 4.6 to 5.3 mEq/L is associated with the greatest survival in maintenance hemodialysis patients. Hyperkalemic patients who undergo maintenance hemodialysis against lower dialysate bath may have better survival. Limitations of observational studies including confounding by indication should be considered when interpreting these results.
Kovesdy
Csaba P
CP
Division of Nephrology, Salem Veterans Affairs Medical Center, Salem, Virginia, USA.
Regidor
Deborah L
DL
Mehrotra
Rajnish
R
Jing
Jennie
J
McAllister
Charles J
CJ
Greenland
Sander
S
Kopple
Joel D
JD
Kalantar-Zadeh
Kamyar
K
D000368:Aged; D015314:Dialysis Solutions / Q000737:chemistry*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000032:analysis* / Q000097:blood; D006435:Renal Dialysis / Q000401:mortality; D015996:Survival Rate
D015314:Dialysis Solutions; D011188:Potassium