Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score study

dc.contributor.authorRibeiro, Silvia Carreira
dc.contributor.authorFigueiredo, Ana Elizabeth
dc.contributor.authorBarretti, Pasqual [UNESP]
dc.contributor.authorPecoits-Filho, Roberto
dc.contributor.authorMoraes, Thyago Proenca de
dc.contributor.institutionPontificia Universidade Catolica do Paraná (PUCPR)
dc.contributor.institutionPontificia Universidade Catolica do Rio Grande Sul (PUCRS)
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.date.accessioned2015-10-21T13:08:50Z
dc.date.available2015-10-21T13:08:50Z
dc.date.issued2015-06-19
dc.description.abstractBackground and ObjectivesHypokalemia has been consistently associated with high mortality rate in peritoneal dialysis. However, studies investigating if hypokalemia is acting as a surrogate marker of comorbidities or has a direct effect in the risk for mortality have not been studied. Thus, the aim of this study was to analyze the effect of hypokalemia on overall and cause-specific mortality.Design, Setting, Participants and MeasurementsThis is an analysis of BRAZPD II, a nationwide prospective cohort study. All patients on PD for longer than 90 days with measured serum potassium levels were used to verify the association of hypokalemia with overall and cause-specific mortality using a propensity match score to reduce selection bias. In addition, competing risks were also taken into account for the analysis of cause-specific mortality.ResultsThere was a U-shaped relationship between time-averaged serum potassium and all-cause mortality of PD patients. Cardiovascular disease was the main cause of death in the normokalemic group with 133 events (41.8%) followed by PD-non related infections, n=105 (33.0%). Hypokalemia was associated with a 49% increased risk for CV mortality after adjustments for covariates and the presence of competing risks (SHR 1.49; CI95% 1.01-2.21). In contrast, in the group of patients with K < 3.5mEq/L, PD-non related infections were the main cause of death with 43 events (44.3%) followed by cardiovascular disease (n=36; 37.1%). For PD-non related infections the SHR was 2.19 (CI95% 1.52-3.14) while for peritonitis was SHR 1.09 (CI95% 0.47-2.49).ConclusionsHypokalemia had a significant impact on overall, cardiovascular and infectious mortality even after adjustments for competing risks. The causative nature of this association suggested by our study raises the need for intervention studies looking at the effect of potassium supplementation on clinical outcomes of PD patients.en
dc.description.affiliationPontificia Univ Catolica Parana PUCPR, Sch Med, Curitiba, Parana, Brazil
dc.description.affiliationPontificia Univ Catolica Rio Grande Sul PUCRS, Grad Program Med &Hlth Sci, Porto Alegre, RS, Brazil
dc.description.affiliationUNESP, Sch Med, Botucatu, SP, Brazil
dc.description.affiliationUnespUNESP, Faculdade de Medicina de Botucatu, Departamento de Clínica Médica, Botucatu, SP, Brazil
dc.description.sponsorshipBaxter Healthcare
dc.format.extent1-13
dc.identifierhttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127453
dc.identifier.citationPlos One. San Francisco: Public Library Science, v. 10, n. 6, p. 1-13, 2015.
dc.identifier.doi10.1371/journal.pone.0127453
dc.identifier.fileWOS000356835000010.pdf
dc.identifier.issn1932-6203
dc.identifier.lattes5496411983893479
dc.identifier.orcid0000-0003-4979-4836
dc.identifier.urihttp://hdl.handle.net/11449/128301
dc.identifier.wosWOS:000356835000010
dc.language.isoeng
dc.publisherPublic Library Science
dc.relation.ispartofPlos One
dc.relation.ispartofjcr2.766
dc.relation.ispartofsjr1,164
dc.rights.accessRightsAcesso aberto
dc.sourceWeb of Science
dc.titleLow serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score studyen
dc.typeArtigo
dcterms.rightsHolderPublic Library Science
unesp.author.lattes5496411983893479[3]
unesp.author.orcid0000-0003-4979-4836[3]
unesp.author.orcid0000-0002-0255-6710[4]
unesp.author.orcid0000-0002-8555-8649[2]
unesp.author.orcid0000-0002-2983-3968[5]
unesp.campusUniversidade Estadual Paulista (Unesp), Faculdade de Medicina, Botucatupt

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