Dietary Potassium Intake and All-Cause Mortality in Adults Treated with Hemodialysis
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- Amelie Bernier-Jean
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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- Germaine Wong
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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- Valeria Saglimbene
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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- Marinella Ruospo
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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- Suetonia C. Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
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- Patrizia Natale
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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- Vanessa Garcia-Larsen
- Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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- David W. Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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- Marcello Tonelli
- University of Calgary, Calgary, Canada
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- Jörgen Hegbrant
- Department of Nephrology, Lund University, Lund, Sweden
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- Jonathan C. Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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- Armando Teixeira-Pinto
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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- Giovanni F.M. Strippoli
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
説明
<jats:sec> <jats:title>Background and objectives</jats:title> <jats:p>Dietary 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.</jats:p> </jats:sec> <jats:sec> <jats:title>Design, setting, participants, & measurements</jats:title> <jats:p>A 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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The 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).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Higher dietary intake of potassium is not associated with hyperkalemia or death in patients treated with hemodialysis.</jats:p> </jats:sec>
収録刊行物
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- Clinical Journal of the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology 16 (12), 1851-1861, 2021-12
Ovid Technologies (Wolters Kluwer Health)