关键词: 血钾变异性, 终末期肾病, 维持性血液透析, 全因死亡, 预后, Cox回归

Abstract: Objective  To explore the correlation between serum potassium variability and long-term prognosis in maintenance hemodialysis patients (MHD). Methods  Baseline data were recruited from MHD patients treated at Beijing Luhe Hospital, Capital Medical University hemodialysis center in January 2018,with follow-up through April 2024.Variability of serum potassium was defined as the coefficient of variation of serum potassium from January 2017 to December 2017，and the statistical analysis was performed after log transformation. According to serum potassium variability, MHD patients were divided into the high potassium variability group（0.080 2-0.215 9）and the low potassium variability group（0.026 5-0.080 1）. Kaplan-Meier survival analysis was used to obtain patient survival probabilities, multivariate Cox hazard regression model was used to explore the association between serum potassium variability and all-cause mortality. Results  A total of 213 patients were included in this study, 58.2% were males, with a mean age of (59.1±13.4) years, a median dialysis vintage of 4.4（2.7, 6.9） years,and the median observation period was 6.0 (2.5, 6.25) years. 104 patients（48.8%） died during the observation period, including 52 cardiovascular deaths (50.0%)， 18 infectious deaths（17.3%），15 cerebrovascular deaths（14.4%）. Kaplan-Meier curves showed that a higher potassium variability coefficient was associated with higher all-cause mortality (Log-rank,χ²=9.119，P=0.025).  After adjusting for potential confounding factors such as age, albumin, serum creatinine, and Kt/V（urea clearance index value）, multivariate Cox regression analysis revealed that the high potassium variability group had a higher risk of all-cause mortality than the low potassium variability group (HR=1.537, 95% CI: 1.026-2.302, P=0.037). Conclusion  Higher serum potassium variability was associated with higher all-cause mortality in MHD patients. More attention should be paid to managing serum potassium levels and their fluctuations in MHD patients.

Key words: serum potassium variability, end-stage kidney disease, maintenance hemodialysis, all-cause mortality, prognosis, Cox regression