Key result
Dialysis with a dialysate potassium concentration of 3 mEq/l versus 2 mEq/l was independently associated with a 14% lower incidence of atrial fibrillation.
Why the study?
Atrial fibrillation disproportionally affects persons on maintenance hemodialysis, but the associations of serum and dialysate potassium concentrations with incident atrial fibrillation are poorly understood.
Does a dialysate potassium concentration of 3 mEq/l compared to 2 mEq/l reduce incident atrial fibrillation in older patients initiating hemodialysis?
Cohort (n=15,190)
Does a dialysate potassium concentration of 3 mEq/l compared to 2 mEq/l reduce incident atrial fibrillation in older patients initiating hemodialysis?
In older patients initiating hemodialysis, a dialysate potassium concentration of 3 mEq/l is associated with a lower incidence of atrial fibrillation compared to 2 mEq/l, supporting the avoidance of lower dialysate potassium solutions.
Answers are grounded in this paper and cite their sources.
Associated with lower AF in incident hemodialysis; leaves open need for RCTs before changing dialysate potassium targets.
Introduction Atrial fibrillation (AF) disproportionally affects persons on maintenance hemodialysis (HD). Associations of serum and dialysate potassium concentrations [K + ] with AF incidence are poorly understood. Methods We conducted a cohort study using Medicare claims merged with clinical data from a dialysis provider to determine whether serum-[K + ] and/or dialysate-[K + ] independently associated with AF incidence. Persons insured by fee-for-service Medicare aged ≥67 years at dialysis initiation and free from diagnosed AF prior to day 120 of dialysis were eligible. Serum-[K + ] and dialysate-[K + ] were assessed in 30-day intervals and patients were followed-up with for AF incidence in subsequent 30-day intervals. Results During 2006 to 2011, 15,190 persons (mean age = 76.3 years) initiating HD had no prior AF diagnosis. Mean serum-[K + ] was 4.5 mEq/l; dialysate-[K + ] was 3 mEq/l in 34% and 2 mEq/l in 52% of patients. Followed-up over 21,907 person-years, 2869 persons had incident AF (incidence/100 person-years, 13.1 [95% confidence interval [CI], 12.6–13.6]). The multivariable-adjusted association of serum-[K + ] with incident AF was J-shaped as follows: relative to a serum-[K + ] of 4.5 mEq/l, lower serum-[K + ] associated with increased AF risk, whereas confidence bands for higher serum-[K + ] indicated no association. Dialysis against a dialysate-[K+] of 3 mEq/l versus 2 mEq/l independently associated with a 14% (95% CI, 5%–24%) lower incidence of AF. No effect modification between serum-[K + ] and dialysate-[K + ] was detected ( P = 0.34). Conclusion Lower serum-[K + ] was independently associated with incident AF whereas elevated serum-[K+] was not. The findings support adoption of dialysate solutions with a dialysate-[K + ] of 3 mEq/l, regardless of patients' serum-[K+], and elimination of lower dialysate-[K+] solutions from practice. Clinical trials randomizing patients to different dialysate-[K + ] are warranted to establish causality.
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Hu et al. (2022) conducted a cohort in Kidney failure initiating hemodialysis (n=15,190). Dialysate potassium concentration of 3 mEq/l vs. Dialysate potassium concentration of 2 mEq/l was evaluated on Incident atrial fibrillation (14% lower incidence, 95% CI 5%-24%). Dialysis with a dialysate potassium concentration of 3 mEq/l versus 2 mEq/l was independently associated with a 14% lower incidence of atrial fibrillation.
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