Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score study
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127453 http://hdl.handle.net/11449/128301 |
Resumo: | Background 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. |
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Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score studyBackground 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.Baxter HealthcarePontificia Univ Catolica Parana PUCPR, Sch Med, Curitiba, Parana, BrazilPontificia Univ Catolica Rio Grande Sul PUCRS, Grad Program Med &Hlth Sci, Porto Alegre, RS, BrazilUNESP, Sch Med, Botucatu, SP, BrazilUNESP, Faculdade de Medicina de Botucatu, Departamento de Clínica Médica, Botucatu, SP, BrazilPublic Library SciencePontificia Universidade Catolica do Paraná (PUCPR)Pontificia Universidade Catolica do Rio Grande Sul (PUCRS)Universidade Estadual Paulista (Unesp)Ribeiro, Silvia CarreiraFigueiredo, Ana ElizabethBarretti, Pasqual [UNESP]Pecoits-Filho, RobertoMoraes, Thyago Proenca de2015-10-21T13:08:50Z2015-10-21T13:08:50Z2015-06-19info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article1-13application/pdfhttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127453Plos One. San Francisco: Public Library Science, v. 10, n. 6, p. 1-13, 2015.1932-6203http://hdl.handle.net/11449/12830110.1371/journal.pone.0127453WOS:000356835000010WOS000356835000010.pdf54964119838934790000-0003-4979-4836Web of Sciencereponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengPlos One2.7661,164info:eu-repo/semantics/openAccess2024-08-14T17:22:48Zoai:repositorio.unesp.br:11449/128301Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-14T17:22:48Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score study |
title |
Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score study |
spellingShingle |
Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score study Ribeiro, Silvia Carreira |
title_short |
Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score study |
title_full |
Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score study |
title_fullStr |
Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score study |
title_full_unstemmed |
Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score study |
title_sort |
Low serum potassium levels increase the infectious-caused mortality in peritoneal dialysis patients: a propensity-matched score study |
author |
Ribeiro, Silvia Carreira |
author_facet |
Ribeiro, Silvia Carreira Figueiredo, Ana Elizabeth Barretti, Pasqual [UNESP] Pecoits-Filho, Roberto Moraes, Thyago Proenca de |
author_role |
author |
author2 |
Figueiredo, Ana Elizabeth Barretti, Pasqual [UNESP] Pecoits-Filho, Roberto Moraes, Thyago Proenca de |
author2_role |
author author author author |
dc.contributor.none.fl_str_mv |
Pontificia Universidade Catolica do Paraná (PUCPR) Pontificia Universidade Catolica do Rio Grande Sul (PUCRS) Universidade Estadual Paulista (Unesp) |
dc.contributor.author.fl_str_mv |
Ribeiro, Silvia Carreira Figueiredo, Ana Elizabeth Barretti, Pasqual [UNESP] Pecoits-Filho, Roberto Moraes, Thyago Proenca de |
description |
Background 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. |
publishDate |
2015 |
dc.date.none.fl_str_mv |
2015-10-21T13:08:50Z 2015-10-21T13:08:50Z 2015-06-19 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127453 Plos One. San Francisco: Public Library Science, v. 10, n. 6, p. 1-13, 2015. 1932-6203 http://hdl.handle.net/11449/128301 10.1371/journal.pone.0127453 WOS:000356835000010 WOS000356835000010.pdf 5496411983893479 0000-0003-4979-4836 |
url |
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127453 http://hdl.handle.net/11449/128301 |
identifier_str_mv |
Plos One. San Francisco: Public Library Science, v. 10, n. 6, p. 1-13, 2015. 1932-6203 10.1371/journal.pone.0127453 WOS:000356835000010 WOS000356835000010.pdf 5496411983893479 0000-0003-4979-4836 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Plos One 2.766 1,164 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
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1-13 application/pdf |
dc.publisher.none.fl_str_mv |
Public Library Science |
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Public Library Science |
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Web of Science reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
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Universidade Estadual Paulista (UNESP) |
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UNESP |
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UNESP |
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Repositório Institucional da UNESP |
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Repositório Institucional da UNESP |
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Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
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1808128134753550336 |