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

2021 ◽  
pp. CJN.08360621
Author(s):  
Amelie Bernier-Jean ◽  
Germaine Wong ◽  
Valeria Saglimbene ◽  
Marinella Ruospo ◽  
Suetonia C. Palmer ◽  
...  
Keyword(s):  
Dietary Intake ◽  
Serum Levels ◽  
Cardiovascular Death ◽  
Hazard Ratio ◽  
Maintenance Hemodialysis ◽  
Food Groups ◽  
Mediation Analyses ◽  
Potassium Intake ◽  
Dietary Potassium ◽  
All Cause Mortality

Background and objectivesDietary 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, & measurementsA 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.ResultsThe 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).ConclusionsHigher dietary intake of potassium is not associated with hyperkalemia or death in patients treated with hemodialysis.

scholarly journals Postdialysis Hypokalemia and All-Cause Mortality in Patients Undergoing Maintenance Hemodialysis

2019 ◽  
Vol 14 (6) ◽  
pp. 873-881 ◽  
Author(s):  
Tsuyoshi Ohnishi ◽  
Miho Kimachi ◽  
Shingo Fukuma ◽  
Tadao Akizawa ◽  
Shunichi Fukuhara
Keyword(s):  
Mortality Rate ◽  
Confidence Interval ◽  
Serum Potassium ◽  
Hazard Ratio ◽  
Maintenance Hemodialysis ◽  
Time Varying ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Dialysis Outcomes

Background and objectivesAlmost half of patients on dialysis demonstrate a postdialysis serum potassium ≤3.5 mEq/L. We aimed to examine the relationship between postdialysis potassium levels and all-cause mortality.Design, setting, patients, & measurementsWe conducted a cohort study of 3967 participants on maintenance hemodialysis from the Dialysis Outcomes and Practice Patterns Study in Japan (2009–2012 and 2012–2015). Postdialysis serum potassium was measured repeatedly at 4-month intervals and used as a time-varying variable. We estimated the hazard ratio of all-cause mortality rate using Cox hazard regression models, with and without adjusting for time-varying predialysis serum potassium. Models were adjusted for baseline characteristics and time-varying laboratory parameters. We also analyzed associations of combinations of pre- and postdialysis potassium with mortality.ResultsThe age of participants at baseline was 65±12 years (mean±SD), 2552 (64%) were men, and 96% were treated with a dialysate potassium level of 2.0 to <2.5 mEq/L. The median follow-up period was 2.6 (interquartile range, 1.3–2.8) years. During the follow-up period, 562 (14%) of 3967 participants died, and the overall mortality rate was 6.7 per 100 person-years. Compared with postdialysis potassium of 3.0 to <3.5 mEq/L, the hazard ratios of postdialysis hypokalemia (<3.0 mEq/L) were 1.84 (95% confidence interval, 1.44 to 2.34) in the unadjusted model, 1.44 (95% confidence interval, 1.14 to 1.82) in the model without adjusting for predialysis serum potassium, and 1.10 (95% confidence interval, 0.84 to 1.44) in the model adjusted for predialysis serum potassium. The combination of pre- and postdialysis hypokalemia was associated with the highest mortality risk (hazard ratio, 1.72; 95% confidence interval, 1.35 to 2.19, reference; pre- and postdialysis nonhypokalemia).ConclusionsPostdialysis hypokalemia was associated with mortality, but this association was not independent of predialysis potassium.

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

2020 ◽  
Author(s):  
Christiane I Ramos ◽  
Ailema González-Ortiz ◽  
Angeles Espinosa-Cuevas ◽  
Carla M Avesani ◽  
Juan Jesus Carrero ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Serum Potassium ◽  
Multivariable Analysis ◽  
Food Groups ◽  
Cross Sectional ◽  
Potassium Intake ◽  
Dietary Potassium ◽  
Dialysis Vintage

Abstract Background Dietary potassium restriction is a strategy to control hyperkalemia in chronic kidney disease (CKD). However, hyperkalemia may result from a combination of clinical conditions. This study aimed to investigate whether dietary potassium or the intake of certain food groups associate with serum potassium in the face of other risk factors. Methods We performed a cross-sectional analysis including a nondialysis-dependent CKD (NDD-CKD) cohort and a hemodialysis (HD) cohort. Dietary potassium intake was assessed by 3-day food records. Underreporters with energy intake lower than resting energy expenditure were excluded. Hyperkalemia was defined as serum potassium &gt;5.0 mEq/L. Results The NDD-CKD cohort included 95 patients {median age 67 [interquartile range (IQR) 55–73] years, 32% with diabetes mellitus (DM), median estimated glomerular filtration rate 23 [IQR 18–29] mL/min/1.73 m2} and the HD cohort included 117 patients [median age 39 (IQR 18–67) years, 50% with DM]. In NDD-CKD, patients with hyperkalemia (36.8%) exhibited lower serum bicarbonate and a tendency for higher serum creatinine, a higher proportion of DM and the use of renin–angiotensin–aldosterone system blockers, but lower use of sodium bicarbonate supplements. No association was found between serum and dietary potassium (r = 0.01; P = 0.98) or selected food groups. Conditions associated with hyperkalemia in multivariable analysis were DM {odds ratio [OR] 3.55 [95% confidence interval (CI) 1.07–11.72]} and metabolic acidosis [OR 4.35 (95% CI 1.37–13.78)]. In HD, patients with hyperkalemia (50.5%) exhibited higher serum creatinine and blood urea nitrogen and lower malnutrition inflammation score and a tendency for higher dialysis vintage and body mass index. No association was found between serum and potassium intake (r = −0.06, P = 0.46) or food groups. DM [OR 4.22 (95% CI 1.31–13.6)] and serum creatinine [OR 1.50 (95% CI 1.24–1.81)] were predictors of hyperkalemia in multivariable analyses. Conclusions Dietary potassium was not associated with serum potassium or hyperkalemia in either NDD-CKD or HD patients. Before restricting dietary potassium, the patient’s intake of potassium should be carefully evaluated and other potential clinical factors related to serum potassium balance should be considered in the management of hyperkalemia in CKD.

scholarly journals Dietary Potassium Intake and 20-Year All-Cause Mortality in Older Adults: The Rancho Bernardo Study

2021 ◽  
Vol 40 (1) ◽  
pp. 46-57
Author(s):  
Jonathan Davitte ◽  
Gail A. Laughlin ◽  
Donna Kritz-Silverstein ◽  
Linda K. McEvoy
Keyword(s):  
Older Adults ◽  
Potassium Intake ◽  
Dietary Potassium ◽  
All Cause Mortality

Serum Obestatin: A Biomarker of Cardiovascular and All-Cause Mortality in Hemodialysis Patients

2018 ◽  
Vol 47 (4) ◽  
pp. 254-265 ◽  
Author(s):  
Ilia Beberashvili ◽  
Anna Katkov ◽  
Inna Sinuani ◽  
Ada Azar ◽  
Gregory Shapiro ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Experimental Studies ◽  
Cardiovascular Death ◽  
Maintenance Hemodialysis ◽  
Necrosis Factor Alpha ◽  
Markers Of Inflammation ◽  
Gut Hormone ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Acyl Ghrelin

Background: Recent experimental studies have suggested that obestatin, a proposed anorexigenic gut hormone and a physiological opponent of acyl-ghrelin, has protective cardiovascular effects. We tested the hypothesis that obestatin is independent of inflammatory mediators and/or acyl-ghrelin in predicting outcomes of the maintenance hemodialysis (MHD) population. Methods: It was a 6-year cohort study on 261 MHD patients. Obestatin, acyl-ghrelin, adipokines (leptin and adiponectin), markers of inflammation and nutrition, prospective all-cause and cardiovascular mortality were studied. Results: During the follow-up, 160 patients died in total, with 74 deaths due to cardiovascular causes. For each ng/mL increase in baseline obestatin level in fully adjusted models (including malnutrition-inflammation score, Interleukin-6 [IL-6], adipokines and acyl-ghrelin), the hazard for death from all causes was 0.90 (95% CI 0.81–0.99) and for cardiovascular death 0.85 (95% CI 0.73–0.99). However, these associations were more robust in the subgroup of patients aged above 71 years: 0.85 (95% CI 0.73–0.98) for all-cause death and 0.66 (95% CI 0.52–0.85) for cardiovascular death. An interaction between high IL-6 (above median) and low obestatin (below median) levels for increased risk of all-cause mortality (synergy index [SI] 5.14, p = 0.001) and cardiovascular mortality (SI 4.81, p = 0.02) emerged in the development of multivariable adjusted models. Interactions were also observed between obestatin, Tumor necrosis factor-alpha, adipokines and acyl-ghrelin, which were associated with mortality risk. Conclusion: Serum obestatin behaves as a biomarker for cardiovascular and all-cause mortality in MHD patients. The prognostic ability of obestatin in this regard is independent of inflammation, nutritional status, acyl-ghrelin’s and adipokines’ activity and is modified by age being very prominent in patients older than 71 years.

Dietary Potassium Intake and Mortality in a Prospective Hemodialysis Cohort

2020 ◽  
Author(s):  
Yoko Narasaki ◽  
Yusuke Okuda ◽  
Sara S. Kalantar ◽  
Amy S. You ◽  
Alejandra Novoa ◽  
...  
Keyword(s):  
Potassium Intake ◽  
Dietary Potassium

LEVELS OF VITAMIN C IN CHAIN SMOKERS

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Simerpreet Kukreja
Keyword(s):  
Cigarette Smoking ◽  
Vitamin C ◽  
Dietary Intake ◽  
Serum Vitamin ◽  
Inverse Correlation ◽  
Serum Levels ◽  
Negative Association ◽  
Alcoholic Beverages ◽  
Vitamin Supplementation ◽  
Dietary Vitamin

Introduction: Cigarette smoking induces many chronic illnesses, but in developed countries it is a preventable risk factor. However, by increasing the protective protection mechanism, it may be possible to alleviate the smoke-induced damage. As smoking risk is minimised by vitamin C intake, it is recommended that smokers should take more vitamin C. This inverse correlation between both vitamin C intake and serum levels and smoking was independent of age, sex, body weight, ethnicity, and consumption of alcoholic beverages. The negative association between cigarette smoking and serum vitamin C levels continued, following further adjustment for dietary vitamin C intake. The risk of severe hypovitaminosis C, especially when not accompanied by vitamin supplementation, has been increased in smokers. These data indicate that the inverse relationship between smoking and serum vitamin C levels exists independently of dietary intake, while smoking adversely affects preferences for vitamin C rich foods. Methods: A survey method was performed, with 50 smokers (S) receiving either 500 mg of vitamin C or placebo (P) daily for 4 weeks, and 50 non-smokers receiving vitamin C without supplementation. All finished the hearing. Both groups were equal and C: 14.2 + /- 1.8 pack-years was the amount of cigarettes smoked. Concentrations of plasma vitamin C increased significantly (p < 0.005) only in the vitamin C supplement community.  Results: At SMHRC Hospital Nagpur, we examined the relationship between smoking and vitamin C status, dietary and serum vitamin C levels of 100 participants. Smokers of 20 cigarettes a day had the lowest dietary intake of vitamin C and serum levels, whereas smokers of 1-19 cigarettes a day had lower intake of vitamin C and serum levels (compared to respondents who had never smoked. This inverse correlation between vitamin C and smoking intake and serum levels was independent of age, sex, body weight, race, and consumption of alcoholic beverages. The negative association between cigarette smoking and serum vitamin C levels continued, following further adjustment for dietary vitamin C intake. In smokers, the risk of severe hypo-vitaminosis C, particularly when not accompanied by vitamin supplementation, has increased. Conclusion: These data indicate that the inverse relationship between smoking and serum vitamin C levels exists independently of dietary intake, while smoking adversely affects preferences for vitamin C rich foods. A balanced diet for smokers will obtain a hearty recommendation at this time, but guidelines should remain cautious about high-dose nutrition supplements. Keywords: Chain Smoker, Vitamin C, hypo-vitaminosis C and cigarette.

Dietary and serum vitamin D and preeclampsia risk in Chinese pregnant women: a matched case–control study

2021 ◽  
pp. 1-26
Author(s):  
Xue-min Huang ◽  
Yan-hua Liu ◽  
Han Zhang ◽  
Yuan Cao ◽  
Wei-feng Dou ◽  
...  
Keyword(s):  
Vitamin D ◽  
Dietary Intake ◽  
Pregnant Women ◽  
Case Control Study ◽  
Serum Levels ◽  
Case Control ◽  
Serum Concentrations ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

Abstract The effect of vitamin D (VD) on the risk of preeclampsia (PE) is uncertain. Few of previous studies focused on the relationship between dietary VD intake and PE risk. Therefore, we conducted this 1:1 matched case-control study to explore the association of dietary VD intake and serum VD concentrations with PE risk in Chinese pregnant women. A total of 440 pairs of participants were recruited during March 2016 to June 2019. Dietary information was obtained using a 78-item semi-quantitative food frequency questionnaire. Serum concentrations of 25(OH)D2 and 25(OH)D3 were measured by liquid chromatography–tandem mass spectrometry. Multivariate conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic splines (RCS) were plotted to evaluate the dose-response relationship of dietary VD intake and serum VD concentrations with PE risk. Compared with the lowest quartile, the ORs of the highest quartile were 0.45 (95%CI: 0.29-0.71, Ptrend = 0.001) for VD dietary intake and 0.26 (95%CI: 0.11-0.60, Ptrend = 0.003) for serum levels after adjusting for confounders. In addition, the RCS analysis suggested a reverse J-shaped relationship between dietary VD intake and PE risk (P-nonlinearity = 0.02). A similar association was also found between serum concentrations of total 25(OH)D and PE risk (P-nonlinearity = 0.02). In conclusion, this study provides evidence that higher dietary intake and serum levels of VD are associated with the lower risk of PE in Chinese pregnant women.

scholarly journals Higher premature atrial complex burden from the Holter examination predicts poor cardiovascular outcome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ting-Chun Huang ◽  
Po-Tseng Lee ◽  
Mu-Shiang Huang ◽  
Pei-Fang Su ◽  
Ping-Yen Liu
Keyword(s):  
Risk Factor ◽  
Dose Response ◽  
Cox Model ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Cardiovascular Death ◽  
Specific Model ◽  
Distribution Model ◽  
All Cause Mortality ◽  
Quartile Group

AbstractPremature atrial complexes (PACs) have been suggested to increase the risk of adverse events. The distribution of PAC burden and its dose–response effects on all-cause mortality and cardiovascular death had not been elucidated clearly. We analyzed 15,893 patients in a medical referral center from July 1st, 2011, to December 31st, 2018. Multivariate regression driven by ln PAC (beats per 24 h plus 1) or quartiles of PAC burden were examined. Older group had higher PAC burden than younger group (p for trend < 0.001), and both genders shared similar PACs distribution. In Cox model, ln PAC remained an independent risk factor for all-cause mortality (hazard ratio (HR) = 1.09 per ln PAC increase, 95% CI = 1.06‒1.12, p < 0.001). PACs were a significant risk factor in cause-specific model (HR = 1.13, 95% CI = 1.05‒1.22, p = 0.001) or sub-distribution model (HR = 1.12, 95% CI = 1.04‒1.21, p = 0.004). In ordinal PAC model, 4th quartile group had significantly higher risk of all-cause mortality than those in 1st quartile group (HR = 1.47, 95% CI = 1.13‒1.94, p = 0.005), but no difference in cardiovascular death were found in competing risk analysis. In subgroup analysis, the risk of high PAC burden was consistently higher than in low-burden group across pre-specified subgroups. In conclusion, PAC burden has a dose response effect on all-cause mortality and cardiovascular death.

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