The Relationship Between The Average Level Of Serum Potassium And Variation With The Prognosis In Peritoneal Dialysis Patients

Objective To investigate the relationship between the average level of serum potassium and variation with the prognosis in peritoneal dialysis(PD)patients.Method Patients treated with PD for more than 1 year in the General Hospital of Ningxia Medical University were enrolled from January 1,2007 to June 30,2016,including clinical information,biochemical and evaluation indicators.All patients were divided into hypokalemia group(K<3.5mmol/l),low normal potassium group(3.5?K<4.5mmol/l),high normal potassium group(4.5?K<5.5mmol/l)and hyperkalemia group(K?5.5mmol/l)according to mean serum potassium level which was calculated from PD initiation to after PD for 3 months,6 months,9 months,12 months.all patients were divided into low variation group(CVSP<7.91%),moderate variation group(7.91%?CVSP<11.04%),higher variation group(11.04%?CVSP<14.97%)and high variation group(CVSP?14.97%)according to Coefficient Variation Of Serum Potassium(CVSP).Statistical Methods of Pearson correlation analysis,spearman correlation analysis,Kaplan-Meier,Single factor Cox regression and Multiple factor Cox regression were applied to explore the related factors of the average level of serum potassium and its variation,risk factors for survival in CAPD patients.Results(1)A total of 356 patients were enrolled.180 cases(50.57%)were male,176cases(49.43%)were female,the average age was 51.57±14.04 years and the median follow-up time was 41.02 months.The primary diseases were primary glomerar disease 181 cases(50.84%).(2)The incidence of hypokalemia and hyperkalemia was 11.24%,2.53%,respectively.It was found that female were more likely to have hypokalemia.We can seehypokalemia group had higher in age,eGFR,Kt/V,fasting blood-glucose,CRP,Prevalence of diabetic nephropathy and incidence of malnutrition(p<0.05),lower BMI,HGB,SALB and SCr(p<0.05),compared with the high normal potassium group.The correlation analysis showed that the average level of serum potassium was positively correlated with BMI and SCr(p<0.05),negatively correlated with age,total Kt/V,eGFR and CRP(p<0.05).Serum potassium variation was positively correlated with age,DN,CRP(p<0.05),negatively correlated with SALB(P<0.05).(3)The end point events:After median follow-up of 41.02 months,119 case of356 patients died(33.43%).The main cause of death was cardiovascular disease(55%).Kaplan-Meier survival curve,Single factor Cox regression analysis showed that hypokalemia group,low normal potassium group,higher variation group,high variation group were risk factors for CVD death and all-cause mortality(p<0.05).Multiple factor Cox regression analysis showed hypokalemia group,low normal potassium group and higher variation group and high variation group were independently risk factors for all-cause mortality(p<0.05).Hypokalemia group,low normal potassium group and high variation group were independently risk factors for CVD death(p<0.05).Conclusion Both low average potassium level and high fluctuation of blood potassium were risk factors for poor prognosis in PD patients.Timely and effective correction of hypokalemia,avoidance of blood potassium fluctuations,and maintenance of blood potassium at a normal high level may reduce the mortality of the patients.