Department of Nephrology, Peking University People's Hospital, Beijing, China.
Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center of Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China.
Ren Fail. 2023 Dec;45(1):2211157. doi: 10.1080/0886022X.2023.2211157.
The role of facility-level serum potassium (sK) variability (FL-SPV) in dialysis patients has not been extensively studied. This study aimed to evaluate the association between FL-SPV and clinical outcomes in hemodialysis patients using data from the China Dialysis Outcomes and Practice Patterns Study (DOPPS) 5. FL-SPV was defined as the standard deviation (SD) of baseline sK of all patients in each dialysis center. The mean and SD values of FL-SPV of all participants were calculated, and patients were divided into the high FL-SPV (>the mean value) and low FL-SPV (≤the mean value) groups. Totally, 1339 patients were included, with a mean FL-SPV of 0.800 mmol/L. Twenty-three centers with 656 patients were in the low FL-SPV group, and 22 centers with 683 patients were in the high FL-SPV group. Multivariate logistic regression analysis showed that liver cirrhosis (OR = 4.682, 95% CI: 1.246-17.593), baseline sK (<3.5 vs. 3.5 ≤ sK < 5.5 mmol/L, OR = 2.394, 95% CI: 1.095-5.234; ≥5.5 vs. 3.5 ≤ sK < 5.5 mmol/L, OR = 1.451, 95% CI: 1.087-1.939), dialysis <3 times/week (OR = 1.472, 95% CI: 1.073-2.020), facility patients' number (OR = 1.088, 95% CI: 1.058-1.119), serum HCO level (OR = 0.952, 95% CI: 0.921-0.984), dialysis vintage (OR = 0.919, 95% CI: 0.888-0.950), other cardiovascular disease (OR = 0.508, 95% CI: 0.369-0.700), and using high-flux dialyzer (OR = 0.425, 95% CI: 0.250-0.724) were independently associated with high FL-SPV (all < .05). After adjusting potential confounders, high FL-SPV was an independent risk factor for all-cause death (HR = 1.420, 95% CI: 1.044-1.933) and cardiovascular death (HR = 1.827, 95% CI: 1.188-2.810). Enhancing the management of sK of hemodialysis patients and reducing FL-SPV may improve patient survival.
在透析患者中，设施层面血清钾（sK）变异性（FL-SPV）的作用尚未得到广泛研究。本研究旨在使用中国透析结果和实践模式研究（DOPPS）5 的数据评估 FL-SPV 与血液透析患者临床结局之间的关系。FL-SPV 定义为每个透析中心所有患者基线 sK 的标准差（SD）。计算所有参与者的 FL-SPV 的平均值和 SD 值，并将患者分为高 FL-SPV（>平均值）和低 FL-SPV（≤平均值）组。共纳入 1339 例患者，FL-SPV 的平均值为 0.800mmol/L。23 个中心的 656 例患者为低 FL-SPV 组，22 个中心的 683 例患者为高 FL-SPV 组。多变量 logistic 回归分析显示，肝硬化（OR=4.682，95%CI：1.246-17.593）、基线 sK（<3.5 vs. 3.5≤sK<5.5mmol/L，OR=2.394，95%CI：1.095-5.234；≥5.5 vs. 3.5≤sK<5.5mmol/L，OR=1.451，95%CI：1.087-1.939）、透析<3 次/周（OR=1.472，95%CI：1.073-2.020）、设施患者人数（OR=1.088，95%CI：1.058-1.119）、血清 HCO 水平（OR=0.952，95%CI：0.921-0.984）、透析年限（OR=0.919，95%CI：0.888-0.950）、其他心血管疾病（OR=0.508，95%CI：0.369-0.700）和使用高通量透析器（OR=0.425，95%CI：0.250-0.724）与高 FL-SPV 独立相关（均<0.05）。在调整潜在混杂因素后，高 FL-SPV 是全因死亡（HR=1.420，95%CI：1.044-1.933）和心血管死亡（HR=1.827，95%CI：1.188-2.810）的独立危险因素。加强对血液透析患者 sK 的管理并降低 FL-SPV 可能会提高患者的生存率。
