Acute kidney injury following coronary revascularization procedures in patients with advanced CKD

Gatwood

et al. 2021

JMCP

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BACKGROUND: Patients with advanced chronic kidney disease (CKD) are at high risk for dyskalemias, which may induce arrhythmias that require immediate emergent or hospital care. The association of dyskalemias with short-term hospital/emergency room (ER) visits in advanced CKD is understudied. OBJECTIVE:To assess the association of dyskalemias with short-term hospital/ER visits in an advanced CKD population. METHODS:From among 102,477 US veterans transitioning to dialysis from 2007 to 2015, we identified 21,366 patients with 2 predialysis outpatient eGFR < 30 ml/min/1.73m 2 90-365 days apart (with the second eGFR serving as the index date) and at least 1 potassium (K) in the baseline period (1 year before index) and 1 outpatient K (oK) in the follow-up (1 year after the index but before dialysis initiation). We examined the association of time-varying hypokalemia (K < 3.5 mEq/L) and hyperkalemia (K > 5.5 mEq/L) vs referent (3.5-5.5 mEq/L) with separate hospital and ER visits within 2 calendar days following each oK value over the 1-year follow-up period from the index. We used generalized estimating equations with binary distribution and logit link to model the exposureoutcome relationship adjusted for various

Section: Study Populationmentioning

confidence: 99%

Association of dyskalemias with short-term health care utilization in patients with advanced CKD

Gatwood

et al. 2021

JMCP

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“…We analyzed data from the Transition of Care in CKD (TC-CKD) cohort, a nationally representative historical cohort of US veterans with incident ESRD transitioning to dialysis from October 1, 2007 (first dialysis transition date), through March 31, 2015 (last dialysis transition date) [17, 18]. The United States Renal Data System (USRDS) was used to identify a total of 102,477 US veterans as a source population, with a median (interquartile range [25th–75th percentile]) of 6.2 (2.8–9.3) years and 1.6 (0.6–2.3) years of data availability prior to and following dialysis initiation, respectively.…”

Section: Methodsmentioning

confidence: 99%

Potassium Trajectories prior to Dialysis and Mortality following Dialysis Initiation in Patients with Advanced CKD

Potukuchi

et al. 2021

Nephron

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Introduction: Patients with advanced non-dialysis-dependent CKD (NDD-CKD) have a reduced ability for maintaining plasma potassium (K) in normal range. Deviation from normal plasma K ranges is associated with increased mortality; however, the average trajectory of plasma K over time in patients with advanced NDD-CKD and the outcomes associated with plasma K trajectory are unknown. Methods: We identified 34,167 US veterans with advanced NDD-CKD transitioning to dialysis between October 2007 and March 2015 with at least 1 K measurement each year over a 3-year period prior to dialysis transition (3-year prelude). The K trajectory defined as the change in K (slope) per year over the entire 3-year prelude was estimated using linear mixed-effects models. The association between unadjusted (crude) K slope (categorized as stable [−0.09 to 0.09 mEq/L/year], decreasing [≤−0.10 mEq/L/year], and increasing [≥0.10 mEq/L/year]) and time to all-cause and cardiovascular mortality during the 6 months following dialysis initiation was assessed using multivariable-adjusted survival models. Results: The crude and multivariable-adjusted K slopes (mean, 95% CI) over the 3-year prelude were 0.008 (0.0059, 0.0110) and −0.15 mEq/L/year (−0.19, −0.11), respectively. Decreasing K slope was associated with higher multivariable-adjusted risk of all-cause mortality (adjusted hazard ratio [95% CI] vs. stable K slope: 1.08 [1.00–1.17]). No association was observed between K slope and cardiovascular mortality. Discussion/Conclusion: The average intraindividual plasma K trajectory is remarkably stable in patients with advanced NDD-CKD. A decreasing K slope is associated with higher all-cause mortality risk.

“…We assessed longitudinal data from the Transition of Care in Chronic Kidney Disease, a nationally representative historic cohort of US veterans with incident end-stage renal disease transitioning to dialysis from 1 October 2007 (first dialysis transition date) through 31 March 2015 (last dialysis transition date). [18][19][20][21][22] A total of 102,477 US veterans were identified from the United States Renal Data System as a source population, with a median (interquartile range) of 6.2 (2.8-9.3) years and 1.6 (0.6-2.3) years of data availability before and after dialysis initiation, respectively. An initial sample of 60,128 US veterans with nonmissing predialysis plasma K measurements recorded at any Veterans Affairs (VA) facility was identified.…”

Section: Study Populationmentioning

confidence: 99%

Predialysis Potassium Variability and Postdialysis Mortality in Patients With Advanced CKD

Potukuchi

Kidney International Reports

et al. 2021

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Introduction Patients with advanced non–dialysis-dependent chronic kidney disease (NDD-CKD) are prone to potassium (K) imbalances due to reduced kidney function. Both hypo- and hyperkalemia are associated with increased mortality; however, it is unclear if K variability before dialysis initiation is associated with outcomes after dialysis initiation. Methods We identified 34,167 US veterans with advanced NDD-CKD transitioning to dialysis between October 1, 2007, through March 31, 2015, who had at least 1 K measurement each year over a 3-year period before transition (3-year prelude). For each patient, a linear mixed-effects model was used to regress K over time (in years) over the 3-year prelude to derive K variability (square root of the average squared distance between the observed and estimated K). The main outcomes of interest were 6-month all-cause and cardiovascular mortality after dialysis initiation. Multivariable Cox and Fine-Gray competing risk regression adjusted for 3-year prelude K intercept, K slope (per year), demographics, smoking status, comorbidities, length of hospitalizations, body mass index, vascular access type, medications, average estimated glomerular filtration rate, and number of K measurements over the 3-year prelude were used to assess the association of K variability (expressed as quartiles) with all-cause and cardiovascular mortality, respectively. Results Higher prelude K variability was associated with higher multivariable-adjusted risk of all-cause mortality but not cardiovascular mortality (adjusted hazard/subhazard ratios [95% confidence interval] for highest quartile [vs. lowest] of K variability, 1.14 [1.03–1.25] and 0.99 [0.85–1.16] for all-cause and cardiovascular mortality, respectively). Conclusion Higher K variability is associated with higher all-cause mortality after dialysis initiation.