饮食钾摄入量与血液透析患者全因死亡率的关系。
Dietary Potassium Intake and All-Cause Mortality in Adults Treated with Hemodialysis.
机构信息
School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
出版信息
Clin J Am Soc Nephrol. 2021 Dec;16(12):1851-1861. doi: 10.2215/CJN.08360621. Epub 2021 Dec 1.
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 end-stage 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 all-cause 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, -0.01 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.
背景与目的
尽管缺乏证据，但限制接受维持性血液透析患者的钾摄入是标准做法，并且该做法也被纳入了指南。我们旨在评估饮食钾摄入量与死亡率之间的关联，以及高钾血症是否介导这种关联。
设计、地点、参与者和测量方法：在欧洲和南美洲接受维持性血液透析的 8043 名成年人纳入了 DIETary intake, death and hospitalization in adults with end-stage kidney disease treated with HemoDialysis（DIET-HD）研究。我们从全球过敏和哮喘欧洲网络食物频率问卷中测量了基线钾摄入量，并进行了生存时间和中介分析。
结果
基线时的中位钾摄入量为 3.5（四分位距，2.5-5.0）g/d。在中位随访 4.0 年（25890 人年）期间，我们观察到 2921 例（36%）死亡。在调整了包括心脏疾病和食物组在内的基线特征后，饮食钾摄入量与全因死亡率无关（每增加 1 g/d 饮食钾摄入量：风险比，1.00；95%置信区间[95%CI]，0.95 至 1.05）。中介分析显示，钾摄入量与死亡率之间没有关联，无论是通过还是独立于血清钾（风险比，1.00；95%CI，1.00 至 1.00 和风险比，1.01；95%CI，0.96 至 1.06）。钾摄入量与基线时的血清水平（每增加 1 g/d 饮食钾摄入量，血清钾升高 0.03；95%CI，-0.01 至 0.07 mEq/L）或高钾血症（≥6.0 mEq/L）的患病率（比值比，1.11；95%CI，每增加 1 g/d 饮食钾摄入量 1.01；95%CI，0.89 至 1.37）均无显著相关性。高钾血症与心血管死亡相关（风险比，1.23；95%CI，1.03 至 1.48）。
结论
在接受血液透析治疗的患者中，较高的饮食钾摄入量与高钾血症或死亡无关。
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