Why the study?
It was unclear whether potassium variability prior to dialysis initiation is associated with clinical outcomes after dialysis initiation in patients with advanced NDD-CKD.
Does higher predialysis potassium variability increase 6-month all-cause and cardiovascular mortality in patients with advanced CKD transitioning to dialysis?
Does higher predialysis potassium variability increase 6-month all-cause and cardiovascular mortality in patients with advanced CKD transitioning to dialysis?
In patients with advanced CKD transitioning to dialysis, higher predialysis potassium variability is an independent predictor of 6-month all-cause mortality, but not cardiovascular mortality.
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Predialysis K variability may identify higher post-dialysis mortality risk; leaves open whether stabilization improves outcomes in advanced CKD.
INTRODUCTION: Patients with advanced non-dialysis-dependent chronic kidney disease (NDD-CKD) are prone to potassium (K) imbalances due to reduced kidney function. Both hypo- and hyperkalemia are associated with increased mortality; however, it is unclear if K variability before dialysis initiation is associated with outcomes after dialysis initiation. METHODS: We identified 34,167 US veterans with advanced NDD-CKD transitioning to dialysis between October 1, 2007, through March 31, 2015, who had at least 1 K measurement each year over a 3-year period before transition (3-year prelude). For each patient, a linear mixed-effects model was used to regress K over time (in years) over the 3-year prelude to derive K variability (square root of the average squared distance between the observed and estimated K). The main outcomes of interest were 6-month all-cause and cardiovascular mortality after dialysis initiation. Multivariable Cox and Fine-Gray competing risk regression adjusted for 3-year prelude K intercept, K slope (per year), demographics, smoking status, comorbidities, length of hospitalizations, body mass index, vascular access type, medications, average estimated glomerular filtration rate, and number of K measurements over the 3-year prelude were used to assess the association of K variability (expressed as quartiles) with all-cause and cardiovascular mortality, respectively. RESULTS: Higher prelude K variability was associated with higher multivariable-adjusted risk of all-cause mortality but not cardiovascular mortality (adjusted hazard/subhazard ratios [95% confidence interval] for highest quartile [vs. lowest] of K variability, 1.14 [1.03-1.25] and 0.99 [0.85-1.16] for all-cause and cardiovascular mortality, respectively). CONCLUSION: Higher K variability is associated with higher all-cause mortality after dialysis initiation.
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Dashputre et al. (2021) studied this question.
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