Hypokalaemia: an independent risk factor of enterobacteriaceae peritonitis in CAPD patients

Chuang, Ya‐Wen; Shu, Kuo‐Hsiung; Yu, Tung‐Min; Cheng, Chi-Hung; Chen, Cheng‐Hsu

doi:10.1093/ndt/gfn709

Cited by 90 publications

(84 citation statements)

References 24 publications

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“…It has been suggested that low serum potassium levels may alter intestinal motility, which, along with protein-energy wasting often associated with hypokalemia, may impair immunologic defenses. This, in turn, may lead to bacterial overgrowth and enhanced susceptibility to Enterobacteriaceae-associated peritonitis (10,11,25). However, these issues were not addressed in this study and remain speculative.…”

Section: Discussionmentioning

confidence: 87%

“…Our findings are consistent with some previous observations about the association of low serum potassium levels with infectious risk in PD patients. In a recent study, Chuang et al (11) found that the incidence of peritonitis was significantly higher among patients with hypokalemia; the risk was particularly high for infections with Enterobacteriaceae organisms. This is relevant because Gram-negative PD peritonitis is associated with significantly higher risk for either transfer to HD or mortality (23).…”

Section: Discussionmentioning

confidence: 98%

“…Thus, whereas hyperkalemia is commonly associated with advanced kidney disease and seen not infrequently in HD patients, clinical experience and small, single-center studies suggest that hypokalemia may be more common with PD. Furthermore, single-center studies from Taiwan (N=140) and Hong Kong (N=266) have shown an association between hypokalemia in PD patients and Enterobacteriaceae peritonitis and all-cause mortality, respectively (10,11). However, cultural differences influence dietary intakes of potassium (12).…”

Section: Introductionmentioning

confidence: 99%

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Serum Potassium and Cause-Specific Mortality in a Large Peritoneal Dialysis Cohort

Torlén

Kalantar-Zadeh

Molnar

et al. 2012

Clinical Journal of the American Society of Nephrology

126

134

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SummaryBackground and objectives Unlike hemodialysis (HD), peritoneal dialysis (PD) is a continuous therapy and does not induce myocardial stunning. Yet, the death risk in HD and PD patients is similar. This study tested the hypothesis that serum potassium abnormalities contribute more to the death risk in PD patients than in HD patients.Design, setting, participants, & measurements Data from patients treated in DaVita facilities between July 1, 2001 and June 30, 2006 (n=10,468 PD patients; n=111,651 HD patients) were used to determine association of serum potassium with mortality.Results PD patients were significantly more likely to have serum potassium ,4 mEq/L, with an adjusted odds ratio of 3.30 (95% confidence interval [95% CI], 3.05, 3.56). There was a U-shaped relationship between timeaveraged serum potassium and all-cause and cardiovascular mortality of PD patients, with adjusted hazards ratios of 1.51 for all-cause mortality for potassium ,3.5 mEq/L (95% CI, 1.29, 1.76) and 1.52 for potassium $5.5 mEq/L (95% CI, 1.32, 1.75). The population-attributable risks for all-cause mortality for serum potassium ,4.0 and $5.5 mEq/L were 3.6% and 1.9%, respectively, in PD patients, and 0.8% and 1.5%, respectively, in HD patients.Conclusions Abnormalities in serum potassium contribute disproportionately to the high death risk in PD patients. This may, in part, account for the equivalent cardiac risk seen with the two therapies.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Serum Potassium and Cause-Specific Mortality in a Large Peritoneal Dialysis Cohort

Torlén

Kalantar-Zadeh

Molnar

et al. 2012

Clinical Journal of the American Society of Nephrology

126

134

View full text Add to dashboard Cite

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“…2). Chuang et al [14] showed that the prevalence of peritonitis was significantly higher in patients with at least one episode of hypokalemia than those with normokalemia (6.9 vs. 2.1%, respectively, p < 0.001). Although the association was not adjusted for any confounders, there was no correlation between peritonitis and age, body mass index, and gender, with or without diabetes mellitus, as well as comorbidity.…”

Section: Trial Characteristics and Outcomementioning

confidence: 99%

“…The study by Ribeiro et al [12] was well designed for our purposes and performed a propensity score analysis to account for any underlying differences between patients with a timeaveraged potassium under 3.5 mEq/L and others. Although the study with the lowest risk of bias by Su et al [13] excluded cases with acute complication including peritonitis occurred in the previous month, Su et al [13] and Chuang et al [14] had no description about the history of peritonitis. Peritonitis was not present at the start of the other three studies [12,15,16], which included only incident cases of peritoneal dialysis (Table 2).…”

Section: Risk-of-bias and Quality Assessmentmentioning

confidence: 99%

Impact of hypokalemia on peritonitis in peritoneal dialysis patients: a systematic review

et al. 2017

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AbstractsBackground: Hypokalemia is a common electrolyte disorder in peritoneal dialysis patients. Some studies showed the association of serum potassium levels with all-cause and cardiovascular mortality and infection. This review aims to clarify the relationship of hypokalemia and peritonitis in peritoneal dialysis. Methods: The MEDLINE and Cochrane Library databases were searched for articles published from 1990 to May 2016. The following search terms were used: hypokal(a)emia, potassium, peritoneal dialysis, peritonitis, and infection. Additional studies were identified by hand searching through references and using the MEDLINE-related articles option. Two investigators independently selected studies using predefined criteria and assessed each study's quality using the Newcastle-Ottawa Quality Assessment Scale. Results: A total of 159 abstracts were identified and 6 trials were included in the systematic review (n = 3613). One national prospective study and two retrospective single-center studies indicated that hypokalemia increases the risk of peritonitis, whether two single-center studies indicated otherwise. One case-control study indicated that lower potassium level was associated with a poor therapeutic outcome in peritonitis.

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Two‐stage estimation for multivariate recurrent event data with a dependent terminal event

2014

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Recurrent event data arise in longitudinal follow-up studies, where each subject may experience the same type of events repeatedly. The work in this article is motivated by the data from a study of repeated peritonitis for patients on peritoneal dialysis. Due to the aspects of medicine and cost, the peritonitis cases were classified into two types: Gram-positive and non-Gram-positive peritonitis. Further, since the death and hemodialysis therapy preclude the occurrence of recurrent events, we face multivariate recurrent event data with a dependent terminal event. We propose a flexible marginal model, which has three characteristics: first, we assume marginal proportional hazard and proportional rates models for terminal event time and recurrent event processes, respectively; second, the inter-recurrences dependence and the correlation between the multivariate recurrent event processes and terminal event time are modeled through three multiplicative frailties corresponding to the specified marginal models; third, the rate model with frailties for recurrent events is specified only on the time before the terminal event. We propose a two-stage estimation procedure for estimating unknown parameters. We also establish the consistency of the two-stage estimator. Simulation studies show that the proposed approach is appropriate for practical use. The methodology is applied to the peritonitis cohort data that motivated this study.

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Hypokalaemia: an independent risk factor of enterobacteriaceae peritonitis in CAPD patients

Cited by 90 publications

References 24 publications

Serum Potassium and Cause-Specific Mortality in a Large Peritoneal Dialysis Cohort

Serum Potassium and Cause-Specific Mortality in a Large Peritoneal Dialysis Cohort

Impact of hypokalemia on peritonitis in peritoneal dialysis patients: a systematic review

Two‐stage estimation for multivariate recurrent event data with a dependent terminal event

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