Skip to main content

Advertisement

SpringerLink
Log in

Association between annual variability of potassium levels and prognosis in patients undergoing hemodialysis

  • Original article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

Hyperkalemia and hypokalemia are associated with mortality in patients undergoing hemodialysis. However, there are few reports on the association between potassium level fluctuations and mortality. We retrospectively investigated the association between serum potassium level variability and mortality in patients undergoing hemodialysis.

Methods

This study was conducted at a single center. Variability in serum potassium levels was evaluated using the standard deviation of potassium level from July 2011 to June 2012, and its association with prognosis was examined by following up the patients for 5 years. Serum potassium variability was assessed as the coefficient of variation, and the statistical analysis was performed after log transformation.

Results

Among 302 patients (mean age 64.9 ± 13.3; 57.9% male; and median dialysis vintage 70.5 months [interquartile range, IQR 34–138.3]), 135 died during the observation period (median observation period 5.0 years [2.3–5.0]). Although the mean potassium level was not associated with prognosis, serum potassium level variability was associated with prognosis, even after adjustments for confounding factors such as age and dialysis time (hazard ratio: 6.93, 95% confidence interval [Cl] 1.98–25.00, p = 0.001). After the adjustments, the coefficient of variation of potassium level in the highest tertile (T3) showed a higher relative risk for prognosis than that in T1 (relative risk: 1.98, 95% CI 1.19–3.29, p = 0.01).

Conclusions

Variability in serum potassium levels was associated with mortality in patients undergoing hemodialysis. Careful monitoring of potassium levels and their fluctuations is necessary for this patient population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Choi HY, Ha SK. Potassium balances in maintenance hemodialysis. Electrolyte Blood Press. 2013;11:9–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Gumz ML, Rabinowitz L, Wingo CS. An integrated view of potassium homeostasis. N Engl J Med. 2015;373:60–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Lim S. Approach to hypokalemia. Acta Med Indones. 2007;39:56–64.

    PubMed  Google Scholar 

  4. de Rooij ENM, Dekker FW, Le Cessie S, Hoorn EJ, de Fijter JW, Hoogeveen EK, et al. Serum potassium and mortality risk in hemodialysis patients: a cohort study. Kidney Med. 2022;4: 100379.

    Article  PubMed  Google Scholar 

  5. Yamada S, Inaba M. Potassium metabolism and management in patients with CKD. Nutrients. 2021;13:1751.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Pani A, Floris M, Rosner MH, Ronco C. Hyperkalemia in hemodialysis patients. Semin Dial. 2014;27:571–6.

    Article  PubMed  Google Scholar 

  7. Hwang JC, Wang CT, Chen CA, Chen HC. Hypokalemia is associated with increased mortality rate in chronic hemodialysis patients. Blood Purif. 2011;32:254–61.

    Article  CAS  PubMed  Google Scholar 

  8. Kovesdy CP, Regidor DL, Mehrotra R, Jing J, McAllister CJ, Greenland S, et al. Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clin J Am Soc Nephrol. 2007;2:999–1007.

    Article  CAS  PubMed  Google Scholar 

  9. Brunelli SM, Du Mond C, Oestreicher N, Rakov V, Spiegel DM. Serum potassium and short-term clinical outcomes among hemodialysis patients: Impact of the long interdialytic interval. Am J Kidney Dis. 2017;70:21–9.

    Article  CAS  PubMed  Google Scholar 

  10. Paice B, Gray JMB, McBride D, Donnelly T, Lawson DH. Hyperkalaemia in patients in hospital. Br Med J (Clin Res Ed). 1983;286:1189–92.

    Article  CAS  PubMed  Google Scholar 

  11. Kim Y, Yun SH, Koo H, Hwang S, Kim HJ, Lee S, et al. Different seasonal variations of potassium in hemodialysis patients with high longitudinal potassium levels: a multicenter cohort study using DialysisNet. Yonsei Med J. 2021;62:315.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Nakazato Y, Kurane R, Hirose S, Watanabe A, Shimoyama H. Variability of laboratory parameters is associated with frailty markers and predicts non-cardiac mortality in hemodialysis patients. Clin Exp Nephrol. 2015;19:1165–78.

    Article  CAS  PubMed  Google Scholar 

  13. Wong MMY, McCullough KP, Bieber BA, Bommer J, Hecking M, Levin NW, et al. Interdialytic weight gain: trends, predictors, and associated outcomes in the international dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis. 2017;69:367–79.

    Article  PubMed  Google Scholar 

  14. Montford JR, Linas S. How dangerous is hyperkalemia? J Am Soc Nephrol. 2017;28:3155.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Ma L, Zhang X, Chen H. TWIK-1 two-pore domain potassium channels change ion selectivity and conduct inward leak sodium currents in hypokalemia. Sci Signal. 2011;4:ra37.

    Article  PubMed  Google Scholar 

  16. Skogestad J, Aronsen JM. Hypokalemia-induced arrhythmias and heart failure: new insights and implications for therapy. Front Physiol. 2018;9:1500.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gasparini A, Evans M, Barany P, Xu H, Jernberg T, Ärnlöv J, et al. Plasma potassium ranges associated with mortality across stages of chronic kidney disease: the Stockholm CREAtinine measurements (SCREAM) project. Nephrol Dial Transplant. 2019;34:1534–41.

    Article  CAS  PubMed  Google Scholar 

  18. Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int. 2003;63:793–808.

    Article  PubMed  Google Scholar 

  19. Conn VS, Ruppar TM. Medication adherence outcomes of 771 intervention trials: systematic review and meta-analysis. Prev Med (Baltim). 2017;99:269–76.

    Article  Google Scholar 

  20. Brown-Tortorici AR, Narasaki Y, You AS, Norris KC, Streja E, Peralta RA, et al. The interplay between dietary phosphorous, protein intake, and mortality in a prospective hemodialysis cohort. Nutrients. 2022;14:1–11.

    Article  Google Scholar 

  21. Amodu A, Abramowitz MK. Dietary acid, age, and serum bicarbonate levels among adults in the United States. Clin J Am Soc Nephrol. 2013;8:2034–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Winger RJ, Uribarri J, Lloyd L. Phosphorus-containing food additives: an insidious danger for people with chronic kidney disease. Trends Food Sci Technol. 2012;24:92–102.

    Article  CAS  Google Scholar 

  23. Usvyat LA, Carter M, Thijssen S, Kooman JP, van der Sande FM, Zabetakis P, et al. Seasonal variations in mortality, clinical, and laboratory parameters in hemodialysis patients: a 5-year cohort study. Clin J Am Soc Nephrol. 2012;7:108.

    Article  PubMed  Google Scholar 

  24. Cheung AK, Yan G, Greene T, Daugirdas JT, Dwyer JT, Levin NW, et al. Seasonal variations in clinical and laboratory variables among chronic hemodialysis patients. J Am Soc Nephrol. 2002;13:2345–52.

    Article  PubMed  Google Scholar 

  25. Li SY, Chen JY, Chuang CL, Chen TW. Seasonal variations in serum sodium levels and other biochemical parameters among peritoneal dialysis patients. Nephrol Dial Transplant. 2008;23:687–92.

    Article  PubMed  Google Scholar 

  26. Tsiagka D, Georgianos PI, Pikilidou MI, Vaios V, Roumeliotis S, Syrganis C, et al. Prevalence, recurrence and seasonal variation of hyperkalemia among patients on hemodialysis. Int Urol Nephrol. 2022;54:2327–2334.

  27. Rossignol P, Lamiral Z, Frimat L, Girerd N, Duarte K, Ferreira J, et al. Hyperkalaemia prevalence, recurrence and management in chronic haemodialysis: a prospective multicentre French regional registry 2-year survey. Nephrol Dial Transplant. 2017;32:2112–8.

    Article  CAS  PubMed  Google Scholar 

  28. Yanai M, Satomura A, Uehara Y, Murakawa M, Takeuchi M, Kumasaka K. Circannual rhythm of laboratory test parameters among chronic haemodialysis patients. Blood Purif. 2008;26:196–203.

    Article  PubMed  Google Scholar 

  29. Taguchi C, Kishimoto Y, Fukushima Y, Saita E, Tanaka M, Kondo K. Seasonal variations of polyphenol intake from vegetables and fruits. Nippon Eiyo Shokuryo Gakkaishi. 2017;70:17–22.

    Article  CAS  Google Scholar 

  30. The Council for Science and Technology. Standard tables of food composition in Japan. 2020 (eighth Revised Edition); 2001:157–60

Download references

Acknowledgements

The authors would like to thank Editage (www.editage.com) for English language editing.

Author information

Authors and Affiliations

  1. Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Kosei Yamaguchi, Mineaki Kitamura & Tomoya Nishino

  2. Nagasaki Renal Center, Nagasaki, Japan

    Kosei Yamaguchi, Mineaki Kitamura, Emiko Otsuka, Satoko Notomi & Satoshi Funakoshi

  3. Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan

    Hiroshi Mukae

  4. Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Hiroshi Mukae

Authors
  1. Kosei Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mineaki Kitamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emiko Otsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Satoko Notomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Satoshi Funakoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroshi Mukae
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tomoya Nishino
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KY, MK, and SF designed the study. KY and MK performed the statistical analyses. KY, and MK drafted the document. KY, MK, and EO participated in data collection. SF, HM, and TN supervised data interpretation. All authors have reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Mineaki Kitamura.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

This study was approved by the Nagasaki Renal Center ethics committee (Nagasaki, Japan) (23002) and was conducted following the 1964 Declaration of Helsinki and its later amendments.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yamaguchi, K., Kitamura, M., Otsuka, E. et al. Association between annual variability of potassium levels and prognosis in patients undergoing hemodialysis. Clin Exp Nephrol 27, 873–881 (2023). https://doi.org/10.1007/s10157-023-02368-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-023-02368-4

Keywords

Search

Navigation