Advertisement

Clinical implications and outcome prediction in chronic hemodialysis patients with lower serum potassium×uric acid product

Published:August 20, 2015DOI:https://doi.org/10.1016/j.ejim.2015.06.016

      Abstract

      Background

      The aims of this study were to evaluate correlations between serum potassium (S[K]) and uric acid (S[UA]) in hemodialysis patients and to determine whether lower levels of both S[K] and S[UA] were associated with poor long-term prognoses in these patients.

      Methods

      A cohort of 424 maintenance hemodialysis patients (58 ± 13 years of age; 47% male; 39% with diabetes) from a single center were divided into tertiles based on the product of S[K] × S[UA] (K × UA): Group 1: low K × UA: n = 141; Group 2: median K × UA: n = 141; and Group 3: high K × UA: n = 142. The longest observation period was 60 months.

      Results

      S[K] showed a positive linear correlation with S[UA] (r = 0.33; p < 0.001). In multivariate logistic regression analysis, Group 1 was characterized by hypoalbuminemia (odds ratio [OR] = 0.20, 95% confidence interval (CI) = 0.11–0.35) and lower levels of normalized protein catabolism [nPCR] (OR = 0.10, 95%CI = 0.05–0.22) and phosphate levels (OR = 0.41, 95%CI = 0.33–0.51). In contrast, Group 3 was associated with higher nPCR (OR = 6.07, 95%CI = 2.93–12.50) and albumin levels (OR = 2.12, 95% CI = 2.12–7.00). Compared to the reference (Group 1), the hazard ratio (HR) for long-term mortality was significantly lower in Groups 2 (HR = 0.65, 95%CI = 0.43–0.99) and 3 (HR = 0.56, 95%CI = 0.36–0.89). In multivariate Cox proportional analysis, the risk of mortality decreased by 2% (HR = 0.98; 95%CI = 0.96–0.99) per 1 unit increase in K × UA product.

      Conclusion

      Hemodialysis patients with lower S[K] and [UA] levels were characterized by hypoalbuminemia and lower nPCR, and they were associated with a long-term mortality risk.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Krishnasamy R.
        • Badve S.V.
        • Hawley C.M.
        • McDonald S.P.
        • Boudville N.
        • Brown F.G.
        • et al.
        Daily variation in death in patients treated by long-term dialysis: comparison of in-center hemodialysis to peritoneal and home hemodialysis.
        Am J Kidney Dis. 2013; 61: 96-103
        • Kovesdy C.P.
        • Regidor D.L.
        • Mehrotra R.
        • Jing J.
        • McAllister C.J.
        • Greenland S.
        • et al.
        Serum and dialysate potassium concentrations and survival in hemodialysis patients.
        Clin J Am Soc Nephrol. 2007; 2: 999-1007
        • Abe S.
        • Yoshizawa M.
        • Nakanishi N.
        • Yazawa T.
        • Yokota K.
        • Honda M.
        • et al.
        Electrocardiographic abnormalities in patients receiving hemodialysis.
        Am Heart J. 1996; 131: 1137-1144
        • Hwang J.C.
        • Wang C.T.
        • Chen C.A.
        • Chen H.C.
        Hypokalemia is associated with increased mortality rate in chronic hemodialysis patients.
        Blood Purif. 2011; 32: 254-261
        • Krishnan E.
        Reduced glomerular function and prevalence of gout: NHANES 2009–10.
        PLoS One. 2012; 7: e50046
        • Cohen S.D.
        • Kimmel P.L.
        • Neff R.
        • Agodoa L.
        • Abbott K.C.
        Association of incident gout and mortality in dialysis patients.
        J Am Soc Nephrol. 2008; 19: 2204-2210
        • Latif W.
        • Karaboyas A.
        • Tong L.
        • Winchester J.F.
        • Arrington C.J.
        • Pisoni R.L.
        • et al.
        Uric acid levels and all-cause and cardiovascular mortality in the hemodialysis population.
        Clin J Am Soc Nephrol. 2011; 6: 2470-2477
        • Choi H.Y.
        • Ha S.K.
        Potassium balances in maintenance hemodialysis.
        Electrolyte Blood Press. 2013; 11: 9-16
        • Murea M.
        Advanced kidney failure and hyperuricemia.
        Adv Chronic Kidney Dis. 2012; 19: 419-424
        • Depner T.A.
        • Daugirdas J.T.
        Equations for normalized protein catabolic rate based on two-point modeling of hemodialysis urea kinetics.
        J Am Soc Nephrol. 1996; 7: 780-785
        • Hwang J.C.
        • Jiang M.Y.
        • Wang C.T.
        Lower serum potassium combined with lower sodium concentrations predict long-term mortality risk in hemodialysis patients.
        BMC Nephrol. 2013; 14: 269
        • Cooper B.A.
        • Penne E.L.
        • Bartlett L.H.
        • Pollock C.A.
        Protein malnutrition and hypoalbuminemia as predictors of vascular events and mortality in ESRD.
        Am J Kidney Dis. 2004; 43: 61-66
        • Lee S.M.
        • Lee A.L.
        • Winters T.J.
        • Tam E.
        • Jaleel M.
        • Stenvinkel P.
        • et al.
        Low serum uric acid level is a risk factor for death in incident hemodialysis patients.
        Am J Nephrol. 2009; 29: 79-85
        • Suliman M.E.
        • Johnson R.J.
        • García-López E.
        • Qureshi A.R.
        • Molinaei H.
        • Carrero J.J.
        • et al.
        J-shaped mortality relationship for uric acid in CKD.
        Am J Kidney Dis. 2006; 48: 761-771
        • Hsu S.P.
        • Pai M.F.
        • Peng Y.S.
        • Chiang C.K.
        • Ho T.I.
        • Hung K.Y.
        Serum uric acid levels show a ‘J-shaped’ association with all-cause mortality in haemodialysis patients.
        Nephrol Dial Transplant. 2004; 19: 457-462
        • Kand'ár R.
        • Záková P.
        • Muzáková V.
        Monitoring of antioxidant properties of uric acid in humans for a consideration measuring of levels of allantoin in plasma by liquid chromatography.
        Clin Chim Acta. 2006; 365: 249-256
        • Madero M.
        • Sarnak M.J.
        • Wang X.
        • Greene T.
        • Beck G.J.
        • Kusek J.W.
        • et al.
        Uric acid and long-term outcomes in CKD.
        Am J Kidney Dis. 2009; 53: 796-803
        • Navaneethan S.D.
        • Beddhu S.
        Associations of serum uric acid with cardiovascular events and mortality in moderate chronic kidney disease.
        Nephrol Dial Transplant. 2009; 24: 1260-1266