MP556AUTONOMIC DISORDER AND SERUM POTASSIUM LEVEL CHANGE FOR THE RISK FACTORS OF FATAL ARRHYTHMIA IN HEMODIALYSIS PATIENTS

Abstract Background: Regular monitoring of serum potassium after total joint arthroplasty (TJA) is a routine examination, which can detect abnormal serum potassium and reduce adverse events timely caused by postoperative hypokalemia. In this study, we aimed to investigate the incidence and risk factors of hypokalemia after primary total hip and knee replacement.Methods: This study included patients who underwent unilateral total knee or hip arthroplasty in our department from April 2017 to March 2018. The serum potassium level before and after operation was collected and retrospectively analyzed. The differences in age, BMI and other factors between hypokalemia patients and non-hypokalemia patients at different time points after surgery were compared, and then the risk factors of postoperative hypokalemia were analyzed based on multiple logistic regression.Results: The total incidence of postoperative hypokalemia was 53.1%, while the respective rate on the first, third and fifth postoperative day was 12.5%, 40.7% and 9.6%. The serum potassium level on the first, third and fifth postoperative day was 3.84±0.32mmol/l, 3.59±0.34mmol/l and 3.80±0.32mmol/l, while among which, the level on the third day was the lowest (p=0.015). The independent risk factors for hypokalemia after total hip and knee replacement were the level of preoperative serum potassium (p=0.011), preoperative red blood cells (p=0.027), and a history of diabetes (p=0.007).Conclusion: Regular monitoring of serum potassium should be performed after TJA due to hypokalemia was a very common complication. We need to pay more attention to patients’ preoperative potassium and red blood cells, especially patients with diabetes.

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P1445ESPECIALLY HYPOKALEMIA IS A RISK FACTOR FOR ALL-CAUSE MORTALITY IN INCIDENT HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1445 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Esther De Rooij ◽

Friedo W Dekker ◽

Saskia Le Cessie ◽

Johan W De Fijter ◽

Ellen K Hoogeveen

Keyword(s):

Risk Factor ◽

Kidney Function ◽

Serum Potassium ◽

Potassium Level ◽

Proportional Hazards Model ◽

Serum Potassium Level ◽

Hemodialysis Patients ◽

Cox Proportional Hazards Model ◽

Residual Kidney Function ◽

All Cause Mortality

Abstract Background and Aims Both hypo- and hyperkalemia can potentially induce fatal cardiac arrhythmias in the general population. However, little is known about the effect of potassium as a modifiable risk factor in hemodialysis (HD) patients. Therefore, we investigated the relation between serum potassium level and all-cause mortality in incident HD patients and whether there is an optimum serum potassium level to pursue. Method All incident HD patients (>18 y) from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a prospective multi-center cohort study, were included. These patients were followed from the start of their first dialysis treatment until death, transplantation or a maximum of 2 years. Serum potassium levels were obtained at fixed 6-month time intervals and divided into six categories: ≤ 4.0, > 4.0 - ≤ 4.5, > 4.5 - ≤ 5.0, > 5.0 - ≤ 5.5 (reference), > 5.5 - ≤ 6.0 and > 6.0 mmol/L. Using a Cox proportional-hazards model with serum potassium category as a time-dependent variable, hazard ratios (HR) for all-cause mortality were calculated, adjusted for baseline age, sex, current smoking, diabetes and residual kidney function. Results In total, 1278 HD patients were included. At baseline, mean (±SD) age was 64 (±14) years, 60% were men, 23% were current smokers, 21% had diabetes and the median (interquartile range) residual kidney function was 3.0 (1.5-4.8) ml/min/1.73m2. Mean (±SD) serum potassium level was 4.8 (±0.8) mmol/L. The prevalence of the six potassium categories was: 10%, 19%, 26%, 22%, 15% and 8%, respectively. A total of 298 (23%) deaths was observed during 2 years of follow-up. After multivariable adjustment the HR (95% CI) for any death according to the six potassium categories were: 2.5 (1.5-4.3), 1.9 (1.2-3.0), 1.6 (1.0-2.5), 1 (reference), 1.3 (0.8-2.2) and 1.7 (1.0-3.0). Conclusion We found a U-shaped relation between serum potassium and all-cause mortality in incident hemodialysis patients. Especially, low serum potassium was a 2.5-fold stronger risk factor for all-cause mortality compared to normal serum potassium. Our results indicate an optimum serum potassium level between 5.0 - 5.5 mmol/L, emphasizing that potassium lowering therapy should be used with caution in hemodialysis patients.

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The influence of pre-hemodialysis ingestion of mandarin orange on the serum potassium level and the amount of potassium removed by hemodialysis in chronic hemodialysis patients

Nihon Toseki Igakkai Zasshi ◽

10.4009/jsdt.41.415 ◽

2008 ◽

Vol 41 (7) ◽

pp. 415-420

Author(s):

Jun Goto ◽

Hidenobu Iwata ◽

Toshiyuki Shimizu ◽

Susumu Takahashi ◽

Masahito Shirakata ◽

...

Keyword(s):

Serum Potassium ◽

Potassium Level ◽

Serum Potassium Level ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Mandarin Orange

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Serum potassium level and dietary potassium intake as risk factors for stroke

Neurology ◽

10.1212/wnl.60.11.1869 ◽

2003 ◽

Vol 60 (11) ◽

pp. 1869-1871

Author(s):

R. G. Hart ◽

L. A. Pearce ◽

S. Di Legge ◽

J. D. Spence ◽

A. Tamayo ◽

...

Keyword(s):

Risk Factors ◽

Serum Potassium ◽

Potassium Level ◽

Serum Potassium Level ◽

Potassium Intake ◽

Dietary Potassium

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Serum potassium level and dietary potassium intake as risk factors for stroke

Neurology ◽

10.1212/wnl.59.3.314 ◽

2002 ◽

Vol 59 (3) ◽

pp. 314-320 ◽

Cited By ~ 44

Author(s):

D. M. Green ◽

A. H. Ropper ◽

R. A. Kronmal ◽

B. M. Psaty ◽

G. L. Burke

Keyword(s):

Risk Factors ◽

Serum Potassium ◽

Potassium Level ◽

Serum Potassium Level ◽

Potassium Intake ◽

Dietary Potassium

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The Relation Between the Degree of Left Ventricular Mass Regression and Serum Potassium Level Change in Patients With Primary Aldosteronism After Adrenalectomy

Journal of Investigative Medicine ◽

10.1097/jim.0000000000000215 ◽

2015 ◽

Vol 63 (6) ◽

pp. 816-820 ◽

Cited By ~ 3

Author(s):

Che-Wei Liao ◽

Aaron Chen ◽

Yen-Tin Lin ◽

Yi-Yao Chang ◽

Shuo-Meng Wang ◽

...

Keyword(s):

Left Ventricular Mass ◽

Serum Potassium ◽

Primary Aldosteronism ◽

Potassium Level ◽

Serum Potassium Level ◽

Left Ventricular ◽

Level Change ◽

Ventricular Mass

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Serum Potassium Levels and Mortality in Hemodialysis Patients: A Retrospective Cohort Study

American Journal of Nephrology ◽

10.1159/000448341 ◽

2016 ◽

Vol 44 (3) ◽

pp. 179-186 ◽

Cited By ~ 25

Author(s):

Akeem A. Yusuf ◽

Yan Hu ◽

Bhupinder Singh ◽

José A. Menoyo ◽

James B. Wetmore

Keyword(s):

Serum Potassium ◽

Potassium Level ◽

Proportional Hazards ◽

Serum Potassium Level ◽

Short Interval ◽

Hemodialysis Patients ◽

Cox Proportional Hazards ◽

Maintenance Hemodialysis ◽

All Cause Mortality ◽

The Impact

Background: Hyperkalemia is common in patients receiving maintenance hemodialysis. However, few studies have examined the association between serum potassium level and mortality. Methods: This study used annual cohorts of hemodialysis patients during 2007-2010. To determine hyperkalemia prevalence, monthly hyperkalemia was defined as serum potassium level ≥5.5 mEq/l; prevalence was calculated as a ratio of hyperkalemia episodes to follow-up time, reported separately by long and short interdialytic interval. To determine the impact of hyperkalemia on mortality, patients in the 2010 cohort were followed from first potassium measurement until death or a censoring event; hyperkalemia was defined, sequentially, by potassium levels 5.5-6.0 mEq/l at 0.1 mEq/l intervals. Time-dependent Cox proportional hazards modeling was used to estimate the association between hyperkalemia and mortality. Results: The 4 annual cohorts ranged from 28,774 to 36,888 patients. Mean age was approximately 63 years, about 56% were men, 51% were white and 44% had end-stage renal disease caused by diabetes. Hyperkalemia prevalence was consistently estimated at 16.3-16.8 events per 100 patient-months. Prevalence on the day after the long interdialytic interval was 2.0-2.4 times as high as on the day after the short interval. Hyperkalemia, when defined as serum potassium ≥5.7 mEq/l, was associated with all-cause mortality (adjusted hazards ratio (AHR) 1.13, 95% CI 1.01-1.28, p = 0.037, vs. <5.7 mEq/l) after adjustment. AHRs increased progressively as the hyperkalemia threshold increased, reaching 1.37 (95% CI 1.16-1.62, p < 0.0001) for ≥6.0 mEq/l. Conclusions: The long interdialytic interval was associated with increased likelihood of hyperkalemia. Hyperkalemia was associated with all-cause mortality beginning at serum potassium ≥5.7 mEq/l; mortality risk estimates increased ordinally through ≥6.0 mEq/l, suggesting a threshold at which serum potassium becomes substantially more dangerous.

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