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饮食钾摄入量与血液透析患者全因死亡率的关系。

Dietary Potassium Intake and All-Cause Mortality in Adults Treated with Hemodialysis.

机构信息

School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.

出版信息

Clin J Am Soc Nephrol. 2021 Dec;16(12):1851-1861. doi: 10.2215/CJN.08360621. Epub 2021 Dec 1.


DOI:10.2215/CJN.08360621
PMID:34853064
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8729497/
Abstract

BACKGROUND AND OBJECTIVES: Dietary potassium restriction in people receiving maintenance hemodialysis is standard practice and is recommended in guidelines, despite a lack of evidence. We aimed to assess the association between dietary potassium intake and mortality and whether hyperkalemia mediates this association. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A total of 8043 adults undergoing maintenance hemodialysis in Europe and South America were included in the DIETary intake, death and hospitalization in adults with end-stage kidney disease treated with HemoDialysis (DIET-HD) study. We measured baseline potassium intake from the Global Allergy and Asthma European Network food frequency questionnaire and performed time-to-event and mediation analyses. RESULTS: The median potassium intake at baseline was 3.5 (interquartile range, 2.5-5.0) g/d. During a median follow-up of 4.0 years (25,890 person-years), we observed 2921 (36%) deaths. After adjusting for baseline characteristics, including cardiac disease and food groups, dietary potassium intake was not associated with all-cause mortality (per 1 g/d higher dietary potassium intake: hazard ratio, 1.00; 95% confidence interval [95% CI], 0.95 to 1.05). A mediation analysis showed no association of potassium intake with mortality, either through or independent of serum potassium (hazard ratio, 1.00; 95% CI, 1.00 to 1.00 and hazard ratio, 1.01; 95% CI, 0.96 to 1.06, respectively). Potassium intake was not significantly associated with serum levels (0.03; 95% CI, -0.01 to 0.07 mEq/L per 1 g/d higher dietary potassium intake) or the prevalence of hyperkalemia (≥6.0 mEq/L) at baseline (odds ratio, 1.11; 95% CI, 0.89 to 1.37 per 1 g/d higher dietary potassium intake). Hyperkalemia was associated with cardiovascular death (hazard ratio, 1.23; 95% CI, 1.03 to 1.48). CONCLUSIONS: Higher dietary intake of potassium is not associated with hyperkalemia or death in patients treated with hemodialysis.

摘要

背景与目的:尽管缺乏证据,但限制接受维持性血液透析患者的钾摄入是标准做法,并且该做法也被纳入了指南。我们旨在评估饮食钾摄入量与死亡率之间的关联,以及高钾血症是否介导这种关联。

设计、地点、参与者和测量方法:在欧洲和南美洲接受维持性血液透析的 8043 名成年人纳入了 DIETary intake, death and hospitalization in adults with end-stage kidney disease treated with HemoDialysis(DIET-HD)研究。我们从全球过敏和哮喘欧洲网络食物频率问卷中测量了基线钾摄入量,并进行了生存时间和中介分析。

结果:基线时的中位钾摄入量为 3.5(四分位距,2.5-5.0)g/d。在中位随访 4.0 年(25890 人年)期间,我们观察到 2921 例(36%)死亡。在调整了包括心脏疾病和食物组在内的基线特征后,饮食钾摄入量与全因死亡率无关(每增加 1 g/d 饮食钾摄入量:风险比,1.00;95%置信区间[95%CI],0.95 至 1.05)。中介分析显示,钾摄入量与死亡率之间没有关联,无论是通过还是独立于血清钾(风险比,1.00;95%CI,1.00 至 1.00 和风险比,1.01;95%CI,0.96 至 1.06)。钾摄入量与基线时的血清水平(每增加 1 g/d 饮食钾摄入量,血清钾升高 0.03;95%CI,-0.01 至 0.07 mEq/L)或高钾血症(≥6.0 mEq/L)的患病率(比值比,1.11;95%CI,每增加 1 g/d 饮食钾摄入量 1.01;95%CI,0.89 至 1.37)均无显著相关性。高钾血症与心血管死亡相关(风险比,1.23;95%CI,1.03 至 1.48)。

结论:在接受血液透析治疗的患者中,较高的饮食钾摄入量与高钾血症或死亡无关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/827a/8729497/061aa8a13500/CJN.08360621absf1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/827a/8729497/061aa8a13500/CJN.08360621absf1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/827a/8729497/061aa8a13500/CJN.08360621absf1.jpg

相似文献

[1]
Dietary Potassium Intake and All-Cause Mortality in Adults Treated with Hemodialysis.

Clin J Am Soc Nephrol. 2021-12

[2]
Fruit and Vegetable Intake and Mortality in Adults undergoing Maintenance Hemodialysis.

Clin J Am Soc Nephrol. 2019-1-31

[3]
Does dietary potassium intake associate with hyperkalemia in patients with chronic kidney disease?

Nephrol Dial Transplant. 2021-11-9

[4]
Racial and Ethnic Differences in Mortality Associated with Serum Potassium in a Large Hemodialysis Cohort.

Am J Nephrol. 2017

[5]
Dietary Potassium Intake and Mortality in a Prospective Hemodialysis Cohort.

J Ren Nutr. 2021-7

[6]
Serum Potassium Levels and Mortality in Hemodialysis Patients: A Retrospective Cohort Study.

Am J Nephrol. 2016

[7]
Dietary n-3 polyunsaturated fatty acid intake and all-cause and cardiovascular mortality in adults on hemodialysis: The DIET-HD multinational cohort study.

Clin Nutr. 2017-12-6

[8]
Chronic renal disease progression: treatment strategies and potassium intake.

Semin Nephrol. 2013-5

[9]
Dialysate Potassium, Serum Potassium, Mortality, and Arrhythmia Events in Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS).

Am J Kidney Dis. 2017-2

[10]
Postdialysis Hypokalemia and All-Cause Mortality in Patients Undergoing Maintenance Hemodialysis.

Clin J Am Soc Nephrol. 2019-5-2

引用本文的文献

[1]
Gut microbiome remodeling in chronic kidney disease: implications of kidney replacement therapies and therapeutic interventions.

Front Med (Lausanne). 2025-7-15

[2]
Prevalence, practice pattern, and mortality of hyperkalemia in Chinese patients undergoing hemodialysis in the visualize HD study.

Sci Rep. 2025-7-1

[3]
Managing Hypertension in Chronic Kidney Disease: The Role of Diet and Guideline Recommendations.

J Clin Med. 2025-5-27

[4]
Disaster emergency meal plans for Korean patients who require hemodialysis.

Kidney Res Clin Pract. 2025-3

[5]
Hyperkalemia burden and treatment patterns in Chinese patients on hemodialysis: final analysis of a prospective multicenter cohort study (PRECEDE-K).

Ren Fail. 2024-12

[6]
Plant-based diet in hyperkalemic chronic kidney disease patients receiving sodium zirconium cyclosilicate: a feasibility clinical trial.

Am J Clin Nutr. 2024-9

[7]
The potassium puzzle: exploring the intriguing connection to albuminuria.

Front Nutr. 2024-5-27

[8]
Seasonal variation of serum potassium in hemodialysis patients: myth or reality? A narrative review of literature.

Ren Fail. 2024-12

[9]
Factors influencing self-care management in adult hemodialysis patients: An integrative review.

Qatar Med J. 2024-3-14

[10]
Re-Thinking Hyperkalaemia Management in Chronic Kidney Disease-Beyond Food Tables and Nutrition Myths: An Evidence-Based Practice Review.

Nutrients. 2023-12-19

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