Potassium, phosphorus levels are not definitive judgements for dialysis adherence
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Physicians should avoid judging patient adherence to dialysis based on their potassium or phosphorus levels, according to data recently published in the American Journal of Kidney Diseases.
“Nonadherence after transplantation is an important contributor to allograft loss. In the evaluation process, transplant physicians try to prospectively identify patients who will have adherence difficulties but there is limited objective data to guide us. Many physicians rely on adherence to dialysis as a surrogate marker, but this can be confounded by other things (dietary preferences, overall state of health, transportation issues etc.),” Deirdre Sawinski, MD, associate professor of medicine at Weill Cornell Medical College, told Healio. “In our study, we aimed to test the association between different dialysis adherence measures that physicians potentially use and post-transplant outcomes.”
In a retrospective cohort, researchers examined five nonadherence metrics in adult patients on maintenance hemodialysis from Jan. 1, 2004, to Dec. 31, 2014. All patients received a kidney transplant at a U.S. center. The five metrics included serum potassium (5.2 mEq/L), serum phosphorus (>5.5 mg/dL), intradialytic weight gain (IDWG, 5 L), shortened treatments (30 minutes) and missed treatments (at least one or more), and all metrics were characterized as the proportion of time under observation.
Researchers divided dialysis observation time into 3-month intervals, and the amount of nonadherent measurements in each domain was evaluated for each interval. Hazard rations for graft loss and mortality, in addition to the odds ratio for rejection, were determined used Cox proportional hazards and logistic regression models.
The primary outcome for this study was allograft loss, and secondary outcomes included mortality and acute rejection in the first year after transplantation.
Models revealed hyperphosphatemia, IDWG and shortened treatments correlated with increased rates of allograft loss, but hyperkalemia did not. However, shortened treatment was linked to greater risk of acute rejection. As missed treatment data were only available between 2004 and 2009, missed treatments only correlated with mortality during that period.
“Our data suggest that physicians should not necessarily judge patient adherence to dialysis on the basis of their potassium or phosphorus levels,” Sawinski told Healio. “Large fluid gains or ending treatments early were associated with poorer transplant outcomes, but we can’t necessarily say this was due to patient nonadherence after transplant (these could be a marker that these individuals are sicker or have other health issues that interfere with dialysis). We could use these metrics to identify patients who may need more support or closer follow-up after transplantation to ensure they have a good outcome.”
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