High prevalence of hyperkalemia in Brazilian chronic dialysis patients and differences across geographic regions  <span class="so-article-trans-title" dir="auto"> Translated title: Prevalência elevada de hipercalemia em pacientes brasileiros em diálise crônica e diferenças entre as regiões geográficas </span>

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Abstract

Introduction:

Hyperkalemia is a common multifactorial condition of people on chronic dialysis and is associated with mortality. We aimed to inform and discuss the prevalence of hyperkalemia in a large population of chronic dialysis patients in Brazil and its geographic regions.

Methods:

Prevalence of hyperkalemia (serum potassium ≥6.0 mEq/L) was assessed in the Brazilian Dialysis Survey (BDS) in July 2019, an online survey of voluntary participation in which all dialysis centers registered at the Brazilian Society of Nephrology were invited.

Results:

Approximately one-third (n=263 of 805) of the Brazilian dialysis clinics participated. The prevalence of hyperkalemia in the whole population was 16.1% (n=7,457 of 46,193; 95%CI=15.8-16.5%,), and varied from 12.1% in the North to 18.7% in the Northeast.

Conclusion:

We found a high prevalence of hyperkalemia in a large Brazilian chronic dialysis population. A nationwide investigation of risk factors, treatment options, and whether this high prevalence contributes to dialysis mortality is warranted.

Resumo

Introdução:

A hipercalemia é uma condição multifatorial comum em pessoas em diálise crônica e está associada à mortalidade. Nosso objetivo foi informar e discutir a prevalência de hipercalemia em uma grande população de pacientes em diálise crônica no Brasil e diferenças entre as regiões geográficas.

Métodos:

A prevalência de hipercalemia (potássio sérico ≥6,0 mEq/L) foi avaliada por meio do Censo Brasileiro de Diálise (CBD) em Julho de 2019, uma pesquisa online de participação voluntária na qual foram convidados todos os centros de diálise registrados na Sociedade Brasileira de Nefrologia.

Resultados:

Aproximadamente um terço (n=263 de 805) das clínicas de diálise brasileiras participaram. A prevalência de hipercalemia na população total foi de 16,1% (n=7.457 de 46.193; IC95%=15,8-16,5%), e variou de 12,1% no Norte a 18,7% no Nordeste.

Conclusão:

Encontramos uma elevada prevalência de hipercalemia em umagrande população brasileira em diálise crônica. É necessária uma investigação nacional dos fatores de risco, opções de tratamento e se esta alta prevalência contribui para a mortalidade desta população.

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Most cited references 21

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Serum and dialysate potassium concentrations and survival in hemodialysis patients.

Csaba P. Kovesdy, Kamyar Kalantar-Zadeh, Joel D. Kopple … (2007)

Controlling serum potassium is an important goal in maintenance hemodialysis patients. We examined the achievement of potassium balance through hemodialysis treatments and the associated fluctuations in serum potassium. A 3-yr (July 2001 to June 2004) cohort of 81,013 maintenance hemodialysis patients from all DaVita dialysis clinics across the United States were studied. Nine quarterly-averaged serum potassium groups ( or = 6.3 mEq/L and seven increments in-between) and four dialysate potassium concentration groups were created in each of the 12 calendar quarters. The death risk associated with predialysis potassium level and dialysate potassium concentration was examined using unadjusted, case-mix adjusted, and malnutrition-inflammation-adjusted time-dependent survival models. Serum potassium correlated with nutritional markers. Serum potassium between 4.6 and 5.3 mEq/L was associated with the greatest survival, whereas potassium or = 5.6 mEq/L was associated with increased mortality. The death risk of serum potassium > or = 5.6 mEq/L remained consistent after adjustments. Higher dialysate potassium concentration was associated with increased mortality in hyperkalemic patients with predialysis serum potassium > or = 5.0 mEq/L. A predialysis serum potassium of 4.6 to 5.3 mEq/L is associated with the greatest survival in maintenance hemodialysis patients. Hyperkalemic patients who undergo maintenance hemodialysis against lower dialysate bath may have better survival. Limitations of observational studies including confounding by indication should be considered when interpreting these results.

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

Jarcy Zee, Steven M. Brunelli, Len Usvyat … (2017)

Background Sudden death is a leading cause of death in patients on maintenance hemodialysis (HD). During HD sessions, the gradient between serum and dialysate levels results in rapid electrolytes shifts, which may contribute to arrhythmias and sudden death. Controversies exist on the optimal electrolyte concentration in the dialysate; specifically, it is unclear whether patient outcomes differ among those treated with dialysate potassium (DK) concentration of 3 mEq/L compared to 2 mEq/L. Study Design Prospective cohort study Setting & Participants 55,183 patients from 20 countries in the Dialysis Outcomes and Practice Patterns Study phases 1–5 (1996–2015). Predictor DK at study entry. Outcomes Cox regression was used to estimate the association between DK and both all-cause mortality and an arrhythmia composite outcome (arrhythmia-related hospitalization or sudden death), adjusting for potential confounders. Results During a median follow-up of 16.5 months, 24% of patients died and 7% had an arrhythmia composite outcome. No meaningful difference in clinical outcomes were observed for patients treated with DK 3 vs. 2 mEq/L; the adjusted hazard ratio (95% CI) was 0.96 (0.91, 1.01) for mortality and 0.98 (0.88, 1.08) for the arrhythmia composite. Results were similar across pre-dialysis serum potassium (SK) levels. As in prior studies, higher SK was associated with adverse outcomes. However, DK only had minimal impact on SK measured pre-dialysis (+0.09 mEq/L SK per 1 mEq/L DK; 95% CI: 0.05, 0.14). Limitations Data were not available on delivered (vs. prescribed) DK and post-dialysis SK; possible unmeasured confounding. Conclusions In combination, these results suggest that approaches other than altering DK concentration (e.g., education on dietary K sources, prescription of K-binding medications) may merit further attention to reduce risks associated with high SK.

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

Christiane I. Ramos, Ailema Janeth González-Ortiz, Angeles Espinosa-Cuevas … (2020)

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. 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 >5.0 mEq/L. 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. 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.

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Author and article information

Journal

Journal ID (nlm-ta): J Bras Nefrol

Journal ID (iso-abbrev): J Bras Nefrol

Journal ID (publisher-id): jbn

Title: Jornal Brasileiro de Nefrologia

Publisher: Sociedade Brasileira de Nefrologia

ISSN (Print): 0101-2800

ISSN (Electronic): 2175-8239

Publication date (Electronic): 29 July 2022

Publication date (Print): Jan-Mar 2023

Volume: 45

Issue: 1

Pages: 106-109

Affiliations

[1 ]Fundação Pró-Rim, Joinville, SC, Brazil

[2 ]Universidade da Região de Joinville, Joinville, SC, Brazil

[3 ]Universidade Federal de São Paulo, São Paulo, SP, Brazil

[4 ]Universidade Federal Fluminense, Niterói, RJ, Brazil

Author notes

Correspondence to: Fabiana Baggio Nerbass. E-mail: fabiana.nerbass@ 123456gmail.com

Authors’ Contribution: All authors contributed substantially to the conception or design of the study; the collection, analysis or interpretation of data; the writing of the manuscript or its critical review; and the final approval of the version to be published.

Conflict of Interest: The authors declare that they have no conflict of interest related to the publication of this manuscript.

Author information

Fabiana Baggio Nerbass http://orcid.org/0000-0001-9936-0185

Helbert do Nascimento Lima http://orcid.org/0000-0003-0081-6897

Ricardo Sesso http://orcid.org/0000-0002-1062-0073

Jocemir Ronaldo Lugon http://orcid.org/0000-0001-6791-3910

Article

DOI: 10.1590/2175-8239-JBN-2022-0053en

PMC ID: 10139716

PubMed ID: 35920444

SO-VID: 81081a2e-b18e-48bd-a2e8-8c38b57265c3

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 25 March 2022

Date accepted : 22 May 2022

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High prevalence of hyperkalemia in Brazilian chronic dialysis patients and differences across geographic regions Translated title: Prevalência elevada de hipercalemia em pacientes brasileiros em diálise crônica e diferenças entre as regiões geográficas

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Most cited references 21

Serum and dialysate potassium concentrations and survival in hemodialysis patients.

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

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

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