Huang Chien-Wei, Lee Min-Jing, Lee Po-Tsang, Hsu Chih-Yang, Huang Wei-Chieh, Chen Chien-Liang, Chou Kang-Ju, Fang Hua-Chang
Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
PLoS One. 2015 Oct 6;10(10):e0139886. doi: 10.1371/journal.pone.0139886. eCollection 2015.
Hyperkalemia increases the risk of sudden cardiac death (SCD) in hemodialysis patients. Our objective was to determine the association between administering low potassium dialysate to hyperkalemic hemodialysis patients and SCD.
We conducted a retrospective cohort study with patients undergoing maintenance hemodialysis from May 1, 2006, through December 31, 2013. The dialysate composition was adjusted over time according to monthly laboratory results. A 1.0 mEq/L potassium dialysate was applied in patients with predialysis hyperkalemia (>5.5 mEq/L) and was included as a time-dependent confounding factor. The clinical characteristics of enrolled patients, the incidence and timing of SCD and risk factors for all-cause mortality and SCD were analyzed.
There were 312 patients on maintenance hemodialysis during the study period. One hundred and fifty-seven patients had been dialyzed against a 1.0 mEq/L potassium dialysate at least once. The rates of all-cause mortality and SCD were 48.17 and 20.74 per 1000 patient-years, respectively. A 1.12-fold increase in the risk of SCD in the 24-hour period starting with the hemodialysis procedure and a 1.36-fold increase in the 24 hours preceding a weekly cycle were found (p = 0.017). Multivariate Cox proportional hazards models showed that age, diabetes mellitus and predialysis hyperkalemia (>5.0 mEq/L) were significant predictors of all-cause mortality and SCD. Exposure to 1.0 mEq/L potassium dialysate, Kt/V, and serum albumin were independent protective factors against all-cause mortality. Only exposure to 1.0 mEq/L potassium dialysate significantly prevented SCD (hazard ratio = 0.33, 95% CI = 0.13-0.85).
Using low potassium dialysate in hyperkalemic hemodialysis patients may prevent SCD.
高钾血症会增加血液透析患者心源性猝死（SCD）的风险。我们的目标是确定对高钾血症血液透析患者使用低钾透析液与SCD之间的关联。
我们对2006年5月1日至2013年12月31日期间接受维持性血液透析的患者进行了一项回顾性队列研究。透析液成分根据每月实验室结果随时间进行调整。对于透析前血钾过高（>5.5 mEq/L）的患者应用1.0 mEq/L钾的透析液，并将其作为一个随时间变化的混杂因素纳入研究。分析了纳入患者的临床特征、SCD的发生率和时间以及全因死亡率和SCD的危险因素。
研究期间有312例患者接受维持性血液透析。157例患者至少有一次使用1.0 mEq/L钾的透析液进行透析。全因死亡率和SCD发生率分别为每1000患者年48.17例和20.74例。发现在以血液透析程序开始的24小时内SCD风险增加1.12倍，在每周透析周期前24小时内增加1.36倍（p = 0.017）。多变量Cox比例风险模型显示，年龄、糖尿病和透析前血钾过高（>5.0 mEq/L）是全因死亡率和SCD的重要预测因素。使用1.0 mEq/L钾的透析液、Kt/V和血清白蛋白是预防全因死亡率的独立保护因素。只有使用1.0 mEq/L钾的透析液能显著预防SCD（风险比 = 0.33，95%置信区间 = 0.13 - 0.85）。
在高钾血症血液透析患者中使用低钾透析液可能预防SCD。
