Clinical implications and outcome prediction in chronic hemodialysis patients with lower serum potassium × uric acid product

BackgroundThe aims of this study were to evaluate correlations between serum potassium (S[K]) and uric acid (S[UA]) in hemodialysis patients and to determine whether lower levels of both S[K] and S[UA] were associated with poor long-term prognoses in these patients.MethodsA cohort of 424 maintenance hemodialysis patients (58 ± 13 years of age; 47% male; 39% with diabetes) from a single center were divided into tertiles based on the product of S[K] × S[UA] (K × UA): Group 1: low K × UA: n = 141; Group 2: median K × UA: n = 141; and Group 3: high K × UA: n = 142. The longest observation period was 60 months.ResultsS[K] showed a positive linear correlation with S[UA] (r = 0.33; p < 0.001). In multivariate logistic regression analysis, Group 1 was characterized by hypoalbuminemia (odds ratio [OR] = 0.20, 95% confidence interval (CI) = 0.11–0.35) and lower levels of normalized protein catabolism [nPCR] (OR = 0.10, 95%CI = 0.05–0.22) and phosphate levels (OR = 0.41, 95%CI = 0.33–0.51). In contrast, Group 3 was associated with higher nPCR (OR = 6.07, 95%CI = 2.93–12.50) and albumin levels (OR = 2.12, 95% CI = 2.12–7.00). Compared to the reference (Group 1), the hazard ratio (HR) for long-term mortality was significantly lower in Groups 2 (HR = 0.65, 95%CI = 0.43–0.99) and 3 (HR = 0.56, 95%CI = 0.36–0.89). In multivariate Cox proportional analysis, the risk of mortality decreased by 2% (HR = 0.98; 95%CI = 0.96–0.99) per 1 unit increase in K × UA product.ConclusionHemodialysis patients with lower S[K] and [UA] levels were characterized by hypoalbuminemia and lower nPCR, and they were associated with a long-term mortality risk.