Association of serum potassium variability and long-term prognosis in maintenance hemodialysis patients

doi:10.3969/j.issn.1006-7795.2026.01.020

Abstract

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

CLC Number:

R692

Ma Yeping, Liu Xiaojing, Wang Xiaoqi, Li Zhongxin. Association of serum potassium variability and long-term prognosis in maintenance hemodialysis patients[J]. Journal of Capital Medical University, 2026, 47(1): 157-162.

References

［1］Shibata S, Uchida S. Hyperkalemia in patients undergoing hemodialysis: its pathophysiology and management［J］. Ther Apher Dial, 2022, 26(1): 3－14.
［2］Bansal S, Pergola P E. Current management of hyperkalemia in patients on dialysis［J］. Kidney Int Rep, 2020, 5(6): 779－789.
［3］De Rooij E N M, Dekker F W, Le Cessie S, et al. Serum potassium and mortality risk in hemodialysis patients: a cohort study［J］. Kidney Med, 2022, 4(1): 100379.
［4］Kovesdy C P, Regidor D L, Mehrotra R, et al. Serum and dialysate potassium concentrations and survival in hemodialysis patients［J］. Clin J Am Soc Nephrol, 2007, 2(5): 999－1007.
［5］Weiss J N, Qu Z L, Shivkumar K. Electrophysiology of hypokalemia and hyperkalemia［J］. Circ Arrhythm Electrophysiol, 2017, 10(3): e004667.
［6］Ma L Q, Zhang X X, Chen H J. TWIK－1 two-pore domain potassium channels change ion selectivity and conduct inward leak sodium currents in hypokalemia［J］. Sci Signal, 2011, 4(176): ra37.
［7］Skogestad J, Aronsen J M. Hypokalemia-induced arrhythmias and heart failure: new insights and implications for therapy［J］. Front Physiol, 2018, 9: 1500.
［8］Xu Q D, Xu F H, Fan L, et al. Serum potassium levels and its variability in incident peritoneal dialysis patients: associations with mortality［J］. PLoS One, 2014, 9(1): e86750.
［9］Dashputre A A, Potukuchi P K, Sumida K, et al. Predialysis potassium variability and postdialysis mortality in patients with advanced CKD［J］. Kidney Int Rep, 2021, 6(2): 366－380.
［10］Yamaguchi K, Kitamura M, Otsuka E, et al. Association between annual variability of potassium levels and prognosis in patients undergoing hemodialysis［J］. Clin Exp Nephrol, 2023, 27(10): 873－881.

［11］Zhang H X, Liu J, Liu X, et al. Pre- to post-dialysis potassium gradient and mortality in patients on hemodialysis: a propensity-matched analysis［J］. Ther Apher Dial, 2025, 29(2): 189－199.

［12］Zhao X J, Hou F F, Liang X L, et al. High facility-level serum potassium variability associated with mortality in hemodialysis patients: results from Chinese Dialysis Outcomes and Practice Patterns Study(DOPPS)［J］. Ren Fail, 2023, 45(1): 2211157.

［13］Mercadal L, Lambert O, Couchoud C, et al. Prescription patterns of dialysate potassium and potassium binders and survival on haemodialysis-the French renal epidemiology and information network registry［J］. Nephrol Dial Transplant, 2021, 36(1): 151－159.
［14］He H D, Wu J J, Lu W, et al. A multicenter study of hemodialysis using individualized dialysate potassium concentrations［J］. Ann Palliat Med, 2021, 10(12): 12218－12229.
［15］Fishbane S, Ford M, Fukagawa M, et al. A phase 3b, randomized, double-blind, placebo-controlled study of sodium zirconium cyclosilicate for reducing the incidence of predialysis hyperkalemia［J］. J Am Soc Nephrol, 2019, 30(9): 1723－1733.

[1]	Stroke Prevention Project, National Health Commission, Stroke Prevention and Control Professional Committee of the Chinese Preventive Medicine Association. Chinese expert consensus on cytoprotection based on reperfusion therapy for acute ischemic stroke [J]. Journal of Capital Medical University, 2026, 47(1): 1-9.
[2]	Chen Lu, Jiang Xue, Guo Xinying, Liu Jian, Guo Caixia. Risk factors and prognostic implications of acute myocardial infarction complicated with pericardial effusion [J]. Journal of Capital Medical University, 2025, 46(6): 1033-1043.
[3]	Wang Xiaoqi, Liu Conghui, Shao Feng, Zhou Jingjing, Yang Fan, Li Zhongxin. Reliability and validity of the repeatable battery for assessment of neuropsychological status scale in maintenance hemodialysis patients [J]. Journal of Capital Medical University, 2025, 46(5): 877-884.
[4]	Li Xin, Jiang Wenjian, Han Jie, Zhang Hongjia. Clinical outcomes of mitral valve repair in patients with rheumatic mitral valve disease and risk factors for long-term prognosis [J]. Journal of Capital Medical University, 2025, 46(5): 885-891.
[5]	Mao Wenping, Han Qian, Jiao Fengwei, Wang Jing, Huang Kewu. The predictive value of serum β2M level for prognosis in exacerbated COPD and the results of when it is compared with other inflammatory markers [J]. Journal of Capital Medical University, 2025, 46(4): 718-723.