Clinical Investigation And Prognostic Analysis Of Hypokalemia In Peritoneal Dialysis Patients

Objective:To analyze the prevalence and influencing factors of hypokalemia in patients with continuous ambulatory peritoneal dialysis(CAPD),and to explore the relationship between serum potassium and complications and outcomes of patients with peritoneal dialysis.Methods: This study is a retrospective study.Enrolled CAPD patients who underwent peritoneal dialysis catheterization and regular follow-up at the Second Affiliated Hospital of Guangxi Medical University from January 1,2017 to November 30,2020 as the research subjects.Recorded general data,baseline indicators,serum potassium during follow-up,complications and patient outcomes.Took the time point of returning to the hospital for reexamination in 1month after peritoneal dialysis catheterization as the baseline,and followed-up to the clinical endpoint event(all-cause death or withdrawal from peritoneal dialysis),or followed-up to December 31,2020 for those who did not have an endpoint event.Inclusion criteria:(1)peritoneal dialysis patients aged ≥ 18 years;(2)CAPD peritoneal dialysis time ≥ 1 month.Exclusion criteria:(1)patients with temporary peritoneal dialysis;(2)patients with severe liver insufficiency or malignant tumors;(3)patients with severe lack of data.Investigated the prevalence of hypokalemia and changes in serum potassium levels;divided the patients into hypokalemia and non-hypokalemia groups,compared the differences in data between the two groups,and analyzed the factors that affect hypokalemia;and analyzed the influence of serum potassium and potassium fluctuations on complications and prognosis of CAPD patients.Results: A total of 120 CAPD patients were enrolled.The male to female ratio was 0.905:1,aged 22-77 years,and the average follow-up time was 18.1months.18 patients developed hypokalemia at baseline,with a prevalence rate of 15.0%.Comparison of hypokalemia and non-hypokalemia groups: the differences in blood phosphorus,blood magnesium,prealbumin,creatinine,uric acid,and total urea clearance index(Kt/V)were statistically significant(P<0.05).Binary Logistic regression analysis indicated that the independent risk factor for hypokalemia was total Kt/V(OR=2.135,95%CI 1.042～4.371,P<0.05),and the protective factor was prealbumin(OR=0.994,95%CI 0.989～1.000,P<0.05).There were differences in the incidence of hypokalemia in different dialysis ages(P<0.05).The incidences of hypokalemia after 1 month,3 months,6 months,1year,and 2 years of peritoneal dialysis were 15.0%,48.3%,31.2%,24.7%,and25.0%,and the incidence was higher in 3 to 6 months after peritoneal dialysis.The incidence of hypokalemia in patients with peritoneal dialysis-related peritonitis was also high.Logistic regression analysis indicated that after adjusting for factors such as BMI,total Kt/V,albumin,potassium variability was still an independent risk factor for all-cause infection in CAPD patients(OR=6.374,95%CI 2.447～16.602,P<0.05).Conclusions: Hypokalemia is a common complication of peritoneal dialysis,with a higher incidence within 3 to 6 months after CAPD.Dialysis adequacy total Kt/V and nutritional index blood prealbumin are the influencing factors of hypokalemia in CAPD patients.Patients with peritoneal dialysis-related peritonitis are more likely to develop hypokalemia,and CAPD patients with high potassium variability have an increased risk of all-cause infection.