TY - JOUR
T1 - Dietary Potassium Intake and All-Cause Mortality in Adults Treated with Hemodialysis
AU - Bernier-Jean, Amelie
AU - Wong, Germaine
AU - Saglimbene, Valeria
AU - Ruospo, Marinella
AU - Palmer, Suetonia C.
AU - Natale, Patrizia
AU - Garcia-Larsen, Vanessa
AU - Johnson, David W.
AU - Tonelli, Marcello
AU - Hegbrant, Jorgen
AU - Craig, Jonathan C.
AU - Teixeira-Pinto, Armando
AU - Strippoli, Giovanni F.M.
N1 - Funding Information:
A. Bernier-Jean was supported by a scholarship from the NHMRC grant GNT1151246 for the completion of this study. J.C. Craig reports serving as coordinating editor of Cochrane Kidney and Transplant, on the editorial boards of Diagnostic and Prognostic Research and Journal of Clinical Epidemiology, and as vice president of Flinders University. J. Hegbrant reports having ownership interest in Diaverum AB and Triomed AB, being employed by JBA Medical AB, and serving as a scientific advisor or member of Red-sense Medical AB. D.W. Johnson reports serving as a scientific advisor or member of American Journal of Kidney Disease, Australian and New Zealand Society of Nephrology (councillor), CJASN, Cochrane Kidney and Transplant Group, International Society of Nephrology (past councillor), International Society of Peritoneal Dialysis (as immediate past president), National Health and Medical Research Council (NHMRC) Academy, and Peritoneal Dialysis International; having other interests in/relationships with Amgen (accommodation sponsorship), Australian and New Zealand Society of Nephrology (as president), and Kidney Health Australia (advisor); having consultancy agreements with AstraZeneca, AWAK, Bayer, and Lilly; receiving research funding from Baxter and Fresenius; receiving honoraria from Baxter, Fresenius, and Ono; and serving on a speakers bureau for Baxter Healthcare and Fresenius Medical Care. A. Teixeira-Pinto reports serving as a scientific advisor or member of the American Health Association. M. Tonelli reports serving as a scientific advisor or member of American Journal of Kidney Diseases, Kidney Diseases, Kidney Disease Improving Global Outcomes, and Kidney International; receiving honoraria from AstraZeneca (lecture fees); receiving a lecture fee from B. Braun in 2019 (the fee was donated to charity); and having other interests in/relationships with Canadian Institutes of Health Research. All remaining authors have nothing to disclose.
Publisher Copyright:
© 2021 by the American Society of Nephrology.
PY - 2021/12
Y1 - 2021/12
N2 - Background and objectives 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. Design, setting, participants, & measurements 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 endstage 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. Results 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 allcause 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, 20.01 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). Conclusions Higher dietary intake of potassium is not associated with hyperkalemia or death in patients treated with hemodialysis.
AB - Background and objectives 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. Design, setting, participants, & measurements 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 endstage 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. Results 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 allcause 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, 20.01 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). Conclusions Higher dietary intake of potassium is not associated with hyperkalemia or death in patients treated with hemodialysis.
UR - http://www.scopus.com/inward/record.url?scp=85122074190&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85122074190&partnerID=8YFLogxK
U2 - 10.2215/CJN.08360621
DO - 10.2215/CJN.08360621
M3 - Article
C2 - 34853064
AN - SCOPUS:85122074190
SN - 1555-9041
VL - 16
SP - 1851
EP - 1861
JO - Clinical journal of the American Society of Nephrology : CJASN
JF - Clinical journal of the American Society of Nephrology : CJASN
IS - 12
ER -