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Observational Study
. 2025 Jul 1;15(1):22405.
doi: 10.1038/s41598-025-92609-1.

Prevalence, practice pattern, and mortality of hyperkalemia in Chinese patients undergoing hemodialysis in the visualize HD study

Zhao Xinju  1 , Xing Changying  2 , Liu Hong  3 , Li Guisen  4 , Zhang Ping  5 , Wang Caili  6 , Xiong Zuying  7 , Xu Gang  8 , Wang Rong  9 , Li Rongshan  10 , Jiang Aili  11 , Jiang Hongli  12 , Wan Jianxin  13 , Wang Xiaoling  14 , Yang Jing  15 , Yao Li  16 , Wang Pei  17 , Zhang Rui  18 , Liao Yunhua  19 , Luo Huimin  20 , Xu Jinsheng  21 , Chen Menghua  22 , Li Yinhui  23 , Chen Qinkai  24 , Yuan Zhongfei  25 , Zha Yan  26 , Li Hong  27 , Hu Wenbo  28 , Lu Chen  29 , Ni Zhaohui  30 , Gao Lingling  31 , Zuo Li  32
Affiliations
Observational Study

Prevalence, practice pattern, and mortality of hyperkalemia in Chinese patients undergoing hemodialysis in the visualize HD study

Zhao Xinju et al. Sci Rep. .

Abstract

Visualize-HD study aimed to examine prevalence of hyperkalemia (HK), associated practice patterns, and mortality in Chinese patients undergoing hemodialysis (HD). The study included patients aged ≥ 18 years and undergoing chronic HD for ≥ 3 months. Primary outcome was to examine the association between suspected risk factors and HK prevalence at the HD facility level. Secondary outcomes were to determine the HK prevalence, management pattern of serum potassium (sK), and risk factors associated with crude mortality. Overall, 50,983 patients undergoing HD from 231 HD centers were enrolled. HK prevalence (sK > 5.0 mmol/L) in patients undergoing HD was 40.84%. Proportion of patients sK > 5.5, > 6.0, > 6.5 mmol/L was 20.42%, 8.7%, and 3.21%, respectively. Three-year cumulative mortality of patients undergoing HD was 21.3%. Notably, 36.7% of deceased patients had HK as indicated by their final sK+ test results. Facilities in high HK prevalence group had a higher all-cause and cardiovascular mortalities compared with low HK prevalence group (20.7% vs. 21.9% and 11.5% vs. 13.5%; P < 0.05). A higher prevalence of hyperphosphatemia [hazard ratio (HR) 1.04 (95% confidence interval (CI): 1.01-1.07)] and more usage of potassium-binding drugs [HR 1.04 (95% CI: 1.00-1.07)] were positively associated with higher HK prevalence for facilities, whereas hypoalbuminemia prevalence and more elderly patients were reversely associated with higher HK prevalence for facilities. HK is prevalent in Chinese HD centers and is associated with risk factors. Chinese HD centers with a higher HK prevalence had higher mortality rates. Although, long-term sK control is important for improving survival in patients undergoing MHD, potassium-binding drugs are underused.Clinical trial registration number: NCT05020717.

Keywords: Facility level; Hemodialysis; Hyperkalemia; Serum potassium.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

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Fig. 1
Fig. 1
The distribution of included reach sites [The map was generated using PowerPoint software (Microsoft 365 MSO. version 2411 Build 16.0.18277.20082)].
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