ArticleClinical kidney journal2021
Hyperkalemia excursions are associated with an increased risk of mortality and hospitalizations in hemodialysis patients.
Article in Clinical kidney journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 23 citations in OpenAlex.
- Trial
- Efficacy and safety of sodium zirconium cyclosilicate on non-dialysis days for long-term management of chronic hyperkalemia in maintenance hemodialysis: a single-center, prospective, open-label, randomized controlled trial.International urology and nephrology · 2026Article
- Microbiota-derived metabolites and cognitive dysfunction in dialysis patients: mechanisms and targeted therapeutic strategies.Frontiers in microbiology · 2026Review
- Prevalence, practice pattern, and mortality of hyperkalemia in Chinese patients undergoing hemodialysis in the visualize HD study.Scientific reports · 2025Observational
- Development and Validation of a Risk Prediction Model for Interdialytic Hyperkalemia in Patients Undergoing Maintenance Hemodialysis.Risk management and healthcare policy · 2025Article
- Associations between serum potassium variability and mortality in patients undergoing maintenance hemodialysis: a retrospective study.Scientific reports · 2024Article
- Hyperkalemia burden and treatment patterns in Chinese patients on hemodialysis: final analysis of a prospective multicenter cohort study (PRECEDE-K).Renal failure · 2024Article
- Cost-Utility of Real-Time Potassium Monitoring in United States Patients Receiving Hemodialysis.Kidney international reports · 2024Article
- Machine learning models for early prediction of potassium lowering effectiveness and adverse events in patients with hyperkalemia.Scientific reports · 2024Article
- Article
- Hyperkalaemia prevalence and dialysis patterns in Chinese patients on haemodialysis: an interim analysis of a prospective cohort study (PRECEDE-K).BMC nephrology · 2023Observational
- Association of Hyperkalemia and Hypokalemia with Patient Characteristics and Clinical Outcomes in Japanese Hemodialysis (HD) Patients.Journal of clinical medicine · 2023Article
- Prevalence and management of hyperkalemia in chronic kidney disease and heart failure patients in the Gulf Cooperation Council (GCC).Journal of clinical hypertension (Greenwich, Conn.) · 2023Review
- Adverse Gastrointestinal Events With Sodium Polystyrene Sulfonate Use in Patients on Maintenance Hemodialysis: An International Cohort Study.Canadian journal of kidney health and disease · 2023Article
- Hyperkalemia and the Use of New Potassium Binders a Single Center Experience from Vestfold Norway (The PotBind Study).International journal of nephrology and renovascular disease · 2023Article
- Serum potassium variability as a predictor of clinical outcomes in patients with cardiorenal disease or diabetes: a retrospective UK database study.Clinical kidney journal · 2022Article
- Hyperkalemia excursions and risk of mortality and hospitalizations in hemodialysis patients: results from DOPPS-Italy.Journal of nephrology · 2022Article
- High prevalence of hyperkalemia in Brazilian chronic dialysis patients and differences across geographic regions.Jornal brasileiro de nefrologiaArticle
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Authors and funding
8 authors at 7 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHyperkalemia is common among hemodialysis (HD) patients and has been associated with adverse clinical outcomes. Previous studies considered a single serum potassium (K) measurement or time-averaged values, but serum K excursions out of the target range may be more reflective of true hyperkalemia events. We assessed whether hyperkalemia excursions lead to an elevated risk of adverse clinical outcomes.
methodsUsing data from 21 countries in Phases 4-6 (2009-18) of the Dialysis Outcomes and Practice Patterns Study (DOPPS), we investigated the associations between peak serum K level, measured monthly predialysis, over a 4-month period ('peak K') and clinical outcomes over the subsequent 4 months using Cox regression, adjusted for potential confounders.
resultsThe analysis included 62 070 patients contributing a median of 3 (interquartile range 2-6) 4-month periods. The prevalence of hyperkalemia based on peak K was 58% for >5.0, 30% for >5.5 and 12% for >6.0 mEq/L. The all-cause mortality hazard ratio for peak K (reference ≤5.0 mEq/L) was 1.15 [95% confidence interval (CI) 1.09, 1.21] for 5.1-5.5 mEq/L, 1.19 (1.12, 1.26) for 5.6-6.0 mEq/L and 1.33 (1.23, 1.43) for >6.0 mEq/L. Results were qualitatively consistent when analyzing hospitalizations and a cardiovascular composite outcome.
conclusionsAmong HD patients, we identified a lower K threshold (peak K 5.1-5.5 mEq/L) than previously reported for increased risk of hospitalization and mortality, with the implication that a greater proportion (>50%) of the HD population may be at risk. A reassessment of hyperkalemia severity ranges is needed, as well as an exploration of new strategies for effective management of chronic hyperkalemia.
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