| アブストラクト | CONTEXT: Guidelines worldwide recommend potassium replacement of 10 to 40 mmol/L in the initial fluid therapy for patients with diabetic ketoacidosis. However, evidence is lacking as to the association between infused potassium concentration and mortality. OBJECTIVE: We aimed to determine the association between infused potassium concentration and in-hospital mortality. METHODS: Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified inpatients admitted for treatment of diabetic ketoacidosis from July 2010 to March 2018. Patients with kidney dysfunction or serum potassium abnormalities were excluded. We evaluated the association of the potassium concentration in the total infused solutions in the first 2 days of hospitalization with 28-day in-hospital mortality using multivariable regression analysis with a cubic spline model. We also assessed the association between potassium concentration and occurrence of hyperkalemia. RESULTS: We identified 14 216 patients with diabetic ketoacidosis and observed 261 deaths. The quartile cut-points for potassium concentration were 7.7, 11.4, and 16.1 mmol/L. Within the range of approximately 10 to 40 mmol/L, potassium concentration was not associated with occurrence of hyperkalemia or death. Lower potassium concentrations were associated with higher 28-day in-hospital mortality; the odds ratio for patients receiving 8 mmol/L was 1.69 (95% CI, 1.03 to 2.78; reference: 20 mmol/L), and the odds ratio increased monotonically as potassium concentration decreased further. CONCLUSION: Patients receiving potassium replacement at concentrations of 10 to 40 mmol/L had similar in-hospital mortality rates, whereas lower concentrations were associated with higher mortality. |
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| ジャーナル名 | The Journal of clinical endocrinology and metabolism |
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| 投稿日 | 2021/1/26 |
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| 投稿者 | Okada, Akira; Yamana, Hayato; Morita, Kojiro; Sato, Yukihito; Yamaguchi, Satoko; Kurakawa, Kayo Ikeda; Michihata, Nobuaki; Matsui, Hiroki; Fushimi, Kiyohide; Nangaku, Masaomi; Yamauchi, Toshimasa; Yasunaga, Hideo; Kadowaki, Takashi |
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| 組織名 | Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate;School of Medicine, The University of Tokyo, Tokyo, Japan.;Department of Health Services Research, Graduate School of Medicine, The;University of Tokyo, Tokyo, Japan.;Department of Health Services Research, University of Tsukuba, Tsukuba, Japan.;Department of Clinical Epidemiology and Health Economics, The University of;Tokyo, Tokyo, Japan.;Department of Health Policy and Informatics, Tokyo Medical and Dental University,;Tokyo, Japan.;Division of Nephrology and Endocrinology, Graduate School of Medicine, The;Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The;Toranomon Hospital, Tokyo, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/33493293/ |
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