Prescription patterns of dialysate potassium and potassium binders and survival on haemodialysis—the French Renal Epidemiology and Information Network registry
Abstract Background Management of potassium disorders in patients on haemodialysis (HD) is complex. We studied prescription patterns of dialysate potassium and potassium binders, and their associations with patient survival. Methods This national registry-based study included 25 629 incident adult p...
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| Veröffentlicht in: | Nephrology, dialysis, transplantation dialysis, transplantation, 2021-01, Vol.36 (1), p.151-159 |
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| creator | Mercadal, Lucile Lambert, Oriane Couchoud, Cécile Metzger, Marie Edet, Stéphane Merle, Sylvie Jacquelinet, Christian Stengel, Bénédicte |
| description | Abstract
Background
Management of potassium disorders in patients on haemodialysis (HD) is complex. We studied prescription patterns of dialysate potassium and potassium binders, and their associations with patient survival.
Methods
This national registry-based study included 25 629 incident adult patients alive after 3 months of HD from 2010 through 2013 and followed-up through 31 December 2014. We used Cox proportional hazard models to estimate multiadjusted mortality hazard ratios (HRs) associated with time-dependent exposure to facility-level dialysate potassium concentrations and patient-level potassium binder exposure.
Results
Almost all dialysis units used, and generally most often, dialysate potassium concentrations of 2 mmol/L. During this period, use of concentrations |
| doi_str_mv | 10.1093/ndt/gfaa077 |
| format | Article |
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Background
Management of potassium disorders in patients on haemodialysis (HD) is complex. We studied prescription patterns of dialysate potassium and potassium binders, and their associations with patient survival.
Methods
This national registry-based study included 25 629 incident adult patients alive after 3 months of HD from 2010 through 2013 and followed-up through 31 December 2014. We used Cox proportional hazard models to estimate multiadjusted mortality hazard ratios (HRs) associated with time-dependent exposure to facility-level dialysate potassium concentrations and patient-level potassium binder exposure.
Results
Almost all dialysis units used, and generally most often, dialysate potassium concentrations of 2 mmol/L. During this period, use of concentrations <2 mmol/L tended to decrease and those ≥3 mmol/L to increase. In 2014, 9% of units used a single dialysate formula, 41% used two and 50% three or more. The most frequent combinations were 2 and 3 mmol/L (40%), and <2, 2 and 3 mmol/L (37%). Compared with patients on HD in units using only one dialysate formula, those in units using two or three had adjusted mortality HRs of 0.91 [95% confidence interval (CI) 0.82–1.01] and 0.84 (0.75–0.93), respectively. Potassium binders were prescribed for 37% of all patients at baseline. Adjusted mortality HRs associated with doses <4, 4–8 and ≥8 g/day versus none were 1.22 (95% CI 1.04–1.51), 0.6 (0.54–0.66) and 0.25 (0.24–0.33), respectively.
Conclusions
Diversity in facility-level use of dialysate potassium concentrations and potassium binder use at an appropriate dose appear to be associated with better survival in HD patients.</description><identifier>ISSN: 0931-0509</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/ndt/gfaa077</identifier><identifier>PMID: 32582941</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Dialysis Solutions - chemistry ; Female ; Humans ; Kidney Failure, Chronic - metabolism ; Kidney Failure, Chronic - mortality ; Kidney Failure, Chronic - therapy ; Male ; Middle Aged ; Potassium - chemistry ; Potassium - metabolism ; Prescriptions - statistics & numerical data ; Prognosis ; Registries - statistics & numerical data ; Renal Dialysis - mortality ; Survival Rate</subject><ispartof>Nephrology, dialysis, transplantation, 2021-01, Vol.36 (1), p.151-159</ispartof><rights>The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c386t-522dba1d0179ccb2bfce78bba468f7da785dc86d46aa753e2e99636b9a02d1023</citedby><cites>FETCH-LOGICAL-c386t-522dba1d0179ccb2bfce78bba468f7da785dc86d46aa753e2e99636b9a02d1023</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,1579,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32582941$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mercadal, Lucile</creatorcontrib><creatorcontrib>Lambert, Oriane</creatorcontrib><creatorcontrib>Couchoud, Cécile</creatorcontrib><creatorcontrib>Metzger, Marie</creatorcontrib><creatorcontrib>Edet, Stéphane</creatorcontrib><creatorcontrib>Merle, Sylvie</creatorcontrib><creatorcontrib>Jacquelinet, Christian</creatorcontrib><creatorcontrib>Stengel, Bénédicte</creatorcontrib><title>Prescription patterns of dialysate potassium and potassium binders and survival on haemodialysis—the French Renal Epidemiology and Information Network registry</title><title>Nephrology, dialysis, transplantation</title><addtitle>Nephrol Dial Transplant</addtitle><description>Abstract
Background
Management of potassium disorders in patients on haemodialysis (HD) is complex. We studied prescription patterns of dialysate potassium and potassium binders, and their associations with patient survival.
Methods
This national registry-based study included 25 629 incident adult patients alive after 3 months of HD from 2010 through 2013 and followed-up through 31 December 2014. We used Cox proportional hazard models to estimate multiadjusted mortality hazard ratios (HRs) associated with time-dependent exposure to facility-level dialysate potassium concentrations and patient-level potassium binder exposure.
Results
Almost all dialysis units used, and generally most often, dialysate potassium concentrations of 2 mmol/L. During this period, use of concentrations <2 mmol/L tended to decrease and those ≥3 mmol/L to increase. In 2014, 9% of units used a single dialysate formula, 41% used two and 50% three or more. The most frequent combinations were 2 and 3 mmol/L (40%), and <2, 2 and 3 mmol/L (37%). Compared with patients on HD in units using only one dialysate formula, those in units using two or three had adjusted mortality HRs of 0.91 [95% confidence interval (CI) 0.82–1.01] and 0.84 (0.75–0.93), respectively. Potassium binders were prescribed for 37% of all patients at baseline. Adjusted mortality HRs associated with doses <4, 4–8 and ≥8 g/day versus none were 1.22 (95% CI 1.04–1.51), 0.6 (0.54–0.66) and 0.25 (0.24–0.33), respectively.
Conclusions
Diversity in facility-level use of dialysate potassium concentrations and potassium binder use at an appropriate dose appear to be associated with better survival in HD patients.</description><subject>Aged</subject><subject>Dialysis Solutions - chemistry</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - metabolism</subject><subject>Kidney Failure, Chronic - mortality</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Potassium - chemistry</subject><subject>Potassium - metabolism</subject><subject>Prescriptions - statistics & numerical data</subject><subject>Prognosis</subject><subject>Registries - statistics & numerical data</subject><subject>Renal Dialysis - mortality</subject><subject>Survival Rate</subject><issn>0931-0509</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9O3DAQhy3UqmxpT9wrn6pKKGA7fxwfKwQUCRVUtedoYk92XRI7tR2qvfUheIG-Gk9C2F2qnjiNZuabn0b6CDnk7JgzlZ84k06WHQCTco8seFGxTOR1-Yos5i3PWMnUPnkb40_GmBJSviH7uShroQq-IH9vAkYd7Jisd3SElDC4SH1HjYV-HSEhHX2CGO00UHDmv661zmCIm2mcwp29g57OKSvAwW_PbXz4c59WSM8DOr2i39DNzNloDQ7W93653lxfus6HATY_fMX024dbGnBpYwrrd-R1B33E97t6QH6cn30__ZJdXV9cnn6-ynReVykrhTAtcMO4VFq3ou00yrptoajqThqQdWl0XZmiApBljgKVqvKqVcCE4UzkB-TTNncM_teEMTWDjRr7Hhz6KTai4DJXqq74jB5tUR18jAG7Zgx2gLBuOGuenDSzk2bnZKY_7IKndkDzj32WMAMft4CfxheTHgEGVpxH</recordid><startdate>20210101</startdate><enddate>20210101</enddate><creator>Mercadal, Lucile</creator><creator>Lambert, Oriane</creator><creator>Couchoud, Cécile</creator><creator>Metzger, Marie</creator><creator>Edet, Stéphane</creator><creator>Merle, Sylvie</creator><creator>Jacquelinet, Christian</creator><creator>Stengel, Bénédicte</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210101</creationdate><title>Prescription patterns of dialysate potassium and potassium binders and survival on haemodialysis—the French Renal Epidemiology and Information Network registry</title><author>Mercadal, Lucile ; Lambert, Oriane ; Couchoud, Cécile ; Metzger, Marie ; Edet, Stéphane ; Merle, Sylvie ; Jacquelinet, Christian ; Stengel, Bénédicte</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c386t-522dba1d0179ccb2bfce78bba468f7da785dc86d46aa753e2e99636b9a02d1023</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Dialysis Solutions - chemistry</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney Failure, Chronic - metabolism</topic><topic>Kidney Failure, Chronic - mortality</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Potassium - chemistry</topic><topic>Potassium - metabolism</topic><topic>Prescriptions - statistics & numerical data</topic><topic>Prognosis</topic><topic>Registries - statistics & numerical data</topic><topic>Renal Dialysis - mortality</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mercadal, Lucile</creatorcontrib><creatorcontrib>Lambert, Oriane</creatorcontrib><creatorcontrib>Couchoud, Cécile</creatorcontrib><creatorcontrib>Metzger, Marie</creatorcontrib><creatorcontrib>Edet, Stéphane</creatorcontrib><creatorcontrib>Merle, Sylvie</creatorcontrib><creatorcontrib>Jacquelinet, Christian</creatorcontrib><creatorcontrib>Stengel, Bénédicte</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Nephrology, dialysis, transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mercadal, Lucile</au><au>Lambert, Oriane</au><au>Couchoud, Cécile</au><au>Metzger, Marie</au><au>Edet, Stéphane</au><au>Merle, Sylvie</au><au>Jacquelinet, Christian</au><au>Stengel, Bénédicte</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prescription patterns of dialysate potassium and potassium binders and survival on haemodialysis—the French Renal Epidemiology and Information Network registry</atitle><jtitle>Nephrology, dialysis, transplantation</jtitle><addtitle>Nephrol Dial Transplant</addtitle><date>2021-01-01</date><risdate>2021</risdate><volume>36</volume><issue>1</issue><spage>151</spage><epage>159</epage><pages>151-159</pages><issn>0931-0509</issn><eissn>1460-2385</eissn><abstract>Abstract
Background
Management of potassium disorders in patients on haemodialysis (HD) is complex. We studied prescription patterns of dialysate potassium and potassium binders, and their associations with patient survival.
Methods
This national registry-based study included 25 629 incident adult patients alive after 3 months of HD from 2010 through 2013 and followed-up through 31 December 2014. We used Cox proportional hazard models to estimate multiadjusted mortality hazard ratios (HRs) associated with time-dependent exposure to facility-level dialysate potassium concentrations and patient-level potassium binder exposure.
Results
Almost all dialysis units used, and generally most often, dialysate potassium concentrations of 2 mmol/L. During this period, use of concentrations <2 mmol/L tended to decrease and those ≥3 mmol/L to increase. In 2014, 9% of units used a single dialysate formula, 41% used two and 50% three or more. The most frequent combinations were 2 and 3 mmol/L (40%), and <2, 2 and 3 mmol/L (37%). Compared with patients on HD in units using only one dialysate formula, those in units using two or three had adjusted mortality HRs of 0.91 [95% confidence interval (CI) 0.82–1.01] and 0.84 (0.75–0.93), respectively. Potassium binders were prescribed for 37% of all patients at baseline. Adjusted mortality HRs associated with doses <4, 4–8 and ≥8 g/day versus none were 1.22 (95% CI 1.04–1.51), 0.6 (0.54–0.66) and 0.25 (0.24–0.33), respectively.
Conclusions
Diversity in facility-level use of dialysate potassium concentrations and potassium binder use at an appropriate dose appear to be associated with better survival in HD patients.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>32582941</pmid><doi>10.1093/ndt/gfaa077</doi><tpages>9</tpages></addata></record> |
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| ispartof | Nephrology, dialysis, transplantation, 2021-01, Vol.36 (1), p.151-159 |
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| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Aged Dialysis Solutions - chemistry Female Humans Kidney Failure, Chronic - metabolism Kidney Failure, Chronic - mortality Kidney Failure, Chronic - therapy Male Middle Aged Potassium - chemistry Potassium - metabolism Prescriptions - statistics & numerical data Prognosis Registries - statistics & numerical data Renal Dialysis - mortality Survival Rate |
| title | Prescription patterns of dialysate potassium and potassium binders and survival on haemodialysis—the French Renal Epidemiology and Information Network registry |
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