Maintain The Serum Potassium Level In Hemodialysis Patients Correlation Analysis With Early Clinical Outcome

Background and Purpose:Patients on Maintenance hemodialysis(MHD)have a decreased ability to maintain plasma potassium(K)concentrations within the normal range,particularly those who have recently recovered from End stage renal disease(ESRD)and are transitioning to hemodialysis.This article will study the relationship between serum potassium variability and early clinical outcomes,as well as prognostic factors based on serum potassium level variability in MHD within one year,in order to clarify the target of serum potassium control in early MHD patients and provide a foundation for MHD patients to choose a more comprehensive and reasonable diagnosis and treatment plan.Subjects and Methods:A total of 165 patients were chosen from the second affiliated hospital of Nanchang university who transitioned from ESRD to MHD among September 17,2017 and December 1,2021.The standard deviation(SD)and coefficient of variation(CVSP)of serum potassium values for each patient were calculated by dividing the SD by the mean(100%).Patients were divided into four groups based on quartiles.Dialysis was the end point of the follow-up.After one year,all-cause and cardiovascular death occurred,and the patient was transferred to a hemodialysis center,had a kidney transplant,or was followed up on until December 31,2022.The groups’ baseline data levels were compared.The correlation between serum potassium variability and baseline data was investigated using Spearman correlation analysis.The Kaplan-Meier and Cox proportional hazards regression models were used to assess the relationship between serum potassium variability and all-cause and cardiovascular mortality,as well as the risk variables influencing prognosis.Results:This study enrolled a total of 165 MHD patients.There were 21 all-cause deaths with a median survival duration of 12 months(6～26 months),with 11 deaths related to cardiovascular events.Higher serum potassium variability was linked to an increase in all-cause mortality(log rank=8.62,P=0.03)but not to an increase in cardiovascular mortality(log rank=5.79,P=0.12).Bivariate analysis revealed that the serum potassium coefficient of variation was positively connected with age,baseline serum potassium,and ferritin(P<0.05),but negatively correlated with albumin and creatinine(P<0.05).Age(HR=1.051,95% CI: 1.004～1.100,P=0.03),diabetes(HR=3.310,95% CI: 1.179～9.288,P=0.02),and serum potassium coefficient of variation(HR=1.103,95% CI: 0.990～1.236,P=0.007)were independent risk factors for all-cause mortality in MHD patients,and hemoglobin(HR=0.839,95% CI:0.780～1.050,P=0.01)was its protective factor.Conclusions:Higher serum potassium variability was related with an increased risk of all-cause mortality but not with an increased risk of cardiovascular mortality.Serum potassium coefficient of variation is an independent risk factor for all-cause death in MHD patients.As a result,maintaining steady serum potassium levels can help MHD patients live longer.