Objective To determine the relationship between risk of death in maintenance hemodialysis(MHD)patients and the serum potassium level at the end of a long dialysis period.Methods The clinical data of patients who were treated at Sinopharm Dongfeng General Hospital from 1 September 2018 to 30 August 2021 were collected for a retrospective analysis.Demographic data and the mean serum potassium level at the end of the last 6 months of treatment were collected and recorded.MHD patients were divided into two groups:53 patients in the death group;and 223 patients in the survival group.Patients were further divided into 7 groups based on the potassium level(in mmol/L):<3.5;3.5-3.9;4.0-4.4;4.5-4.9;5.0-5.4;5.5-5.9;and≥6.0.Death among patients as a function of the serum potassium level was then analyzed.The baseline data of patients in the death and survival groups were compared,and logistic regression was used to analyze the relationship between the serum potassium level and the risk of death in MHD patients.Results No significant differences existed between the death and survival groups with respect to the following:gen-der;dialysis age;serum calcium;serum phosphorus;total cholesterol;high-density lipoprotein;low-density li-poprotein;serum intact parathyroid hormone;and co-existing hypertension(P>0.05).In contrast,significant differences were demonstrated between the death and survival groups with respect to the following:age;serum potassium;hemoglobin;albumin;triglycerides;high-sensitive C-reactive protein;co-existing cardiovascular and cerebrovascular diseases;and co-existing diabetes(P<0.05).The 4.0-4.4 mmol/L serum potassium group had the lowest mortality rate(1.81%;5 patients).The<3.5,3.5-3.9,4.5-4.9,5.0-5.4,5.5-5.9,and≥6.0 mmol/L serum potassium groups had mortality rates of 2.89%(8 patients),2.17%(6 patients),2.17%(6 patients),2.89%(8 patients),3.26%(9 patients),and 3.89%(11 patients),respectively.The group with lowest mortality rate(4.0-4.4 mmol/L)was used as the baseline reference;the other 6 groups of MHD patients with different serum potassium levels were included in the univariate logistic regression analysis.There were no significant differences in the risk of death between the 3.5-3.9 and 4.5-4.9 mmol/L groups,and the 4.0-4.4 mmol/L group(P>0.05);however,the risk of death was significantly different between the<3.5,5.0-5.5,5.5-5.9,and≥6.0 mmol/L,and the 4.0-4.4 mmol/L group(P<0.01).Multi-variate logistic regression analysis showed that the serum potassium level,age,and co-existing cardiovascular and cerebrovascular diseases were independent predictors of death in patients with MHD(P<0.05).Conclusions The serum potassium level and risk of death in MHD patients are characterized by a U-shaped curve.Thus,a lower(<3.5 mmol/L)or higher(≥5.0 mmol/L)serum potassium level are associated with a greater risk of death in MHD patients.Therefore,the serum potassium level should be maintained between 3.5 and 5.0 mmol/L during MHD.
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