title: Low Potassium Dialysate as a Protective Factor of Sudden Cardiac Death in Hemodialysis Patients with Hyperkalemia.
abstract: OBJECTIVE
  Hyperkalemia increases the risk of sudden cardiac death (SCD) in hemodialysis patients. Our objective was to determine the association between administering low potassium dialysate to hyperkalemic hemodialysis patients and SCD.
  
  
  METHODS
  We conducted a retrospective cohort study with patients undergoing maintenance hemodialysis from May 1, 2006, through December 31, 2013. The dialysate composition was adjusted over time according to monthly laboratory results. A 1.0 mEq/L potassium dialysate was applied in patients with predialysis hyperkalemia (>5.5 mEq/L) and was included as a time-dependent confounding factor. The clinical characteristics of enrolled patients, the incidence and timing of SCD and risk factors for all-cause mortality and SCD were analyzed.
  
  
  RESULTS
  There were 312 patients on maintenance hemodialysis during the study period. One hundred and fifty-seven patients had been dialyzed against a 1.0 mEq/L potassium dialysate at least once. The rates of all-cause mortality and SCD were 48.17 and 20.74 per 1000 patient-years, respectively. A 1.12-fold increase in the risk of SCD in the 24-hour period starting with the hemodialysis procedure and a 1.36-fold increase in the 24 hours preceding a weekly cycle were found (p = 0.017). Multivariate Cox proportional hazards models showed that age, diabetes mellitus and predialysis hyperkalemia (>5.0 mEq/L) were significant predictors of all-cause mortality and SCD. Exposure to 1.0 mEq/L potassium dialysate, Kt/V, and serum albumin were independent protective factors against all-cause mortality. Only exposure to 1.0 mEq/L potassium dialysate significantly prevented SCD (hazard ratio = 0.33, 95% CI = 0.13-0.85).
  
  
  CONCLUSIONS
  Using low potassium dialysate in hyperkalemic hemodialysis patients may prevent SCD.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Huang
authors.affiliation: Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Min-Jing
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Po-Tsang
authors.initials: PT
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Chih-Yang
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Wei-Chieh
authors.initials: WC
authors.lastname: Huang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Chien-Liang
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Kang-Ju
authors.initials: KJ
authors.lastname: Chou
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Hua-Chang
authors.initials: HC
authors.lastname: Fang
mesh_terms: D000328:Adult; D000368:Aged; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D015314:Dialysis Solutions / Q000737:chemistry*; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000032:analysis*; D065840:Protective Factors; D006435:Renal Dialysis / Q000009:adverse effects*; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D015314:Dialysis Solutions; D011188:Potassium