Yang Changyuan, Hu Xiaoxuan, Ling Xitao, Xiao Cuixia, Duan Ruolan, Qiu Jiamei, Li Qin, Qin Xindong, Zeng Jiahao, Zhang La, Hou Haijing, Peng Yu, Xu Yuan, Su Jingxu, Liu Xusheng, Lindholm Bengt, Johnson David W, Lu Fuhua, Su Guobin
State Key Laboratory of Traditional Chinese Medicine Syndrome, Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Kidney Med. 2024 Oct 18;6(12):100923. doi: 10.1016/j.xkme.2024.100923. eCollection 2024 Dec.
RATIONALE & OBJECTIVE: Hypokalemia is common and potentially life-threatening in patients undergoing peritoneal dialysis (PD). However, the current literature has produced varying results. This study aimed to evaluate the prevalence and adverse outcomes of hypokalemia and the role of potassium supplementation in patients receiving PD.
Systematic review and meta-analysis of randomized controlled trials and observational studies.
SETTING & STUDY POPULATIONS: Adults receiving maintenance PD.
Studies that investigated the prevalence and adverse outcomes of hypokalemia and the effect of potassium supplementation.
Two independent reviewers evaluated studies for eligibility and extracted relevant data.
Random effects meta-analysis was conducted to pool hazard ratios (HRs) and 95% CIs for the outcomes of interest. The certainty of findings was rated according to the Grading of Recommendations Assessment, Development and Evaluation criteria.
Of 3,632 reports identified, 24 studies involving 60,313 participants met the inclusion criteria. The prevalence of hypokalemia was 37.9% (95% CI, 27.2%-52.7%), 17.7% (95% CI, 12.0%-25.9%), and 4.4% (95% CI, 1.9%-10.2%) in patients with potassium level <4.0, 3.5, and 3.0 mmol/L, respectively. Hypokalemia, according to the study's definition, was associated with increased risks of all-cause mortality (HR, 1.49; 95% CI, 1.18-1.89), cardiovascular mortality (HR, 1.50; 95% CI, 1.19-1.88), and PD-associated peritonitis (HR, 1.42; 95% CI, 1.17-1.73). These associations were consistent but with low to very low certainty. The effect of correcting hypokalemia with potassium supplementation in patients undergoing PD remains uncertain.
Heterogeneity persisted across most of the examined subgroups, and observational studies preclude causation.
Hypokalemia is common and portends poorer survival and a higher risk of peritonitis among patients undergoing PD. Further research into the optimal prevention and treatment strategies for hypokalemia is warranted to improve outcomes.
Registered at PROSPERO with registration number CRD42022358236.
低钾血症在接受腹膜透析（PD）的患者中很常见，且可能危及生命。然而，目前的文献得出了不同的结果。本研究旨在评估低钾血症的患病率和不良后果，以及补钾在接受PD治疗的患者中的作用。
对随机对照试验和观察性研究进行系统评价和荟萃分析。
接受维持性PD的成年人。
调查低钾血症患病率和不良后果以及补钾效果的研究。
两名独立的评审员评估研究的合格性并提取相关数据。
采用随机效应荟萃分析来汇总感兴趣结局的风险比（HR）和95%置信区间（CI）。根据推荐分级评估、制定和评价标准对研究结果的确定性进行评级。
在检索到的3632篇报告中，24项研究涉及60313名参与者，符合纳入标准。血钾水平<4.0、3.5和3.0 mmol/L的患者中，低钾血症的患病率分别为37.9%（95%CI，27.2%-52.7%）、17.7%（95%CI，12.0%-25.9%）和4.4%（95%CI，1.9%-10.2%）。根据该研究的定义，低钾血症与全因死亡率增加（HR，1.49；95%CI，1.18-1.89）、心血管死亡率增加（HR，1.50；95%CI，1.19-1.88）以及与PD相关的腹膜炎（HR，1.42；95%CI，1.17-1.73）风险增加相关。这些关联是一致的，但确定性为低至极低。在接受PD治疗的患者中，补钾纠正低钾血症的效果仍不确定。
在大多数研究的亚组中均存在异质性，且观察性研究无法确定因果关系。
低钾血症在接受PD治疗的患者中很常见，预示着生存率较低且腹膜炎风险较高。有必要对低钾血症的最佳预防和治疗策略进行进一步研究，以改善预后。
在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42022358236。
