Institute for Health Outcomes and Policy, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Nephron. 2021;145(3):265-274. doi: 10.1159/000514294. Epub 2021 Mar 22.
Patients with advanced non-dialysis-dependent CKD (NDD-CKD) have a reduced ability for maintaining plasma potassium (K) in normal range. Deviation from normal plasma K ranges is associated with increased mortality; however, the average trajectory of plasma K over time in patients with advanced NDD-CKD and the outcomes associated with plasma K trajectory are unknown.
We identified 34,167 US veterans with advanced NDD-CKD transitioning to dialysis between October 2007 and March 2015 with at least 1 K measurement each year over a 3-year period prior to dialysis transition (3-year prelude). The K trajectory defined as the change in K (slope) per year over the entire 3-year prelude was estimated using linear mixed-effects models. The association between unadjusted (crude) K slope (categorized as stable [-0.09 to 0.09 mEq/L/year], decreasing [≤-0.10 mEq/L/year], and increasing [≥0.10 mEq/L/year]) and time to all-cause and cardiovascular mortality during the 6 months following dialysis initiation was assessed using multivariable-adjusted survival models.
The crude and multivariable-adjusted K slopes (mean, 95% CI) over the 3-year prelude were 0.008 (0.0059, 0.0110) and -0.15 mEq/L/year (-0.19, -0.11), respectively. Decreasing K slope was associated with higher multivariable-adjusted risk of all-cause mortality (adjusted hazard ratio [95% CI] vs. stable K slope: 1.08 [1.00-1.17]). No association was observed between K slope and cardiovascular mortality.
DISCUSSION/CONCLUSION: The average intraindividual plasma K trajectory is remarkably stable in patients with advanced NDD-CKD. A decreasing K slope is associated with higher all-cause mortality risk.
患有晚期非透析依赖型慢性肾脏病（NDD-CKD）的患者维持血浆钾（K）正常范围的能力降低。血浆 K 范围的偏离与死亡率增加有关；然而，在接受晚期 NDD-CKD 治疗的患者中，血浆 K 随时间的平均轨迹以及与血浆 K 轨迹相关的结局尚不清楚。
我们确定了 2007 年 10 月至 2015 年 3 月期间向透析过渡的 34167 名美国退伍军人，在透析过渡前的 3 年内（3 年导言期）每年至少有 1 次 K 测量。使用线性混合效应模型估计整个 3 年导言期内 K 变化（斜率）的 K 轨迹。使用多变量调整后的生存模型评估未经调整（粗）K 斜率（分类为稳定[-0.09 至 0.09 mEq/L/年]、降低[≤-0.10 mEq/L/年]和增加[≥0.10 mEq/L/年]）与透析开始后 6 个月内全因和心血管死亡率之间的关联。
3 年导言期内的粗和多变量调整 K 斜率（平均值，95%CI）分别为 0.008（0.0059，0.0110）和-0.15 mEq/L/年（-0.19，-0.11）。K 斜率降低与全因死亡率的多变量调整后风险增加相关（与稳定 K 斜率相比，调整后的危险比[95%CI]：1.08[1.00-1.17]）。未观察到 K 斜率与心血管死亡率之间的关联。
讨论/结论：晚期 NDD-CKD 患者的个体内血浆 K 平均轨迹非常稳定。K 斜率降低与全因死亡率风险增加相关。
