REGULAR CONTENT
Final ID
429
Type
Original Scientific Research-Oral or Pos
Authors
A Huang1, M Rudnick2, R Cohen2, M Mantell3, J Redmond1, A Brandis1, T Clark1
Institutions
1Radiology, University of Pennsylvania, Philadelphia, PA, 2Medicine (Nephrology), Univerisity of Pennsylvania, Philadelphia, PA, 3Vascular Surgery, Univerisity of Pennsylvania, Philadelphia, PA
Purpose
To identify the prevalence of and risk factors for new or worsened hyperkalemia following percutaneous dialysis access thrombectomy (declot) procedures.
Materials & Methods
A retrospective analysis was performed of a consecutive cohort of 74 dialysis patients (37M/37F, mean age 64.3) undergoing 120 declot procedures (range, 1-5) over a 12 month period. Serum potassium levels were obtained immediately before (n=112) and after (n=120) thrombectomy as part of a QA initiative. The prevalence of pre- (baseline) and post-thrombectomy hyperkalemia were measured, and mean individual change in serum potassium (delta-K) was calculated. Patients were divided into two groups: 1) new or worsened hyperkalemia (defined as post procedure serum potassium > 5.5 mg/dL or ≥ 0.4 mg/dL increase if baseline potassium was >5.5) or 2) normal potassium (or <0.4 mg/dL increase when baseline K was > 5.5 mg/dL). Clinical, procedural and anatomic variables were analyzed as predictors of hyperkalemia using logistic regression.
Results
Mean delta-K for the entire cohort was 0.07 mg/dL+/- 0.7 SD; prevalence of new or worsened hyperkalemia after thrombectomy was 18%. There was a significant difference in the prevalence of post-thrombectomy hyperkalemia between grafts, fistulas, and hybrid accesses (13% vs 28% vs 36%, P=0.02). Variables associated with greater odds of developing new or worsened hyperkalemia were contrast volume >100 mL (OR 8.1, 95% CI: 1.3-52, P=0.028), fluoroscopy time >15 min (OR 2.7, 95% CI: 1.1-7.0, P = 0.045), and procedure time >120 min (OR 2.8, 95% CI 1.1-7.3, P=0.037). Patient age, access age, days since last dialysis session, dialysis access volume, thrombectomy device type and heparin dose were not predictive of post-thrombectomy hyperkalemia.
Conclusions
Procedural complexity, represented in this study using proxy variables of contrast volume, fluoroscopy time, and procedure time, was predictive of new or worsening hyperkalemia after dialysis access thrombectomy. Higher prevalence of hyperkalemia was also seen in patients with hybrid accesses.
Final ID
429
Type
Original Scientific Research-Oral or Pos
Authors
A Huang1, M Rudnick2, R Cohen2, M Mantell3, J Redmond1, A Brandis1, T Clark1
Institutions
1Radiology, University of Pennsylvania, Philadelphia, PA, 2Medicine (Nephrology), Univerisity of Pennsylvania, Philadelphia, PA, 3Vascular Surgery, Univerisity of Pennsylvania, Philadelphia, PA
Purpose
To identify the prevalence of and risk factors for new or worsened hyperkalemia following percutaneous dialysis access thrombectomy (declot) procedures.
Materials & Methods
A retrospective analysis was performed of a consecutive cohort of 74 dialysis patients (37M/37F, mean age 64.3) undergoing 120 declot procedures (range, 1-5) over a 12 month period. Serum potassium levels were obtained immediately before (n=112) and after (n=120) thrombectomy as part of a QA initiative. The prevalence of pre- (baseline) and post-thrombectomy hyperkalemia were measured, and mean individual change in serum potassium (delta-K) was calculated. Patients were divided into two groups: 1) new or worsened hyperkalemia (defined as post procedure serum potassium > 5.5 mg/dL or ≥ 0.4 mg/dL increase if baseline potassium was >5.5) or 2) normal potassium (or <0.4 mg/dL increase when baseline K was > 5.5 mg/dL). Clinical, procedural and anatomic variables were analyzed as predictors of hyperkalemia using logistic regression.
Results
Mean delta-K for the entire cohort was 0.07 mg/dL+/- 0.7 SD; prevalence of new or worsened hyperkalemia after thrombectomy was 18%. There was a significant difference in the prevalence of post-thrombectomy hyperkalemia between grafts, fistulas, and hybrid accesses (13% vs 28% vs 36%, P=0.02). Variables associated with greater odds of developing new or worsened hyperkalemia were contrast volume >100 mL (OR 8.1, 95% CI: 1.3-52, P=0.028), fluoroscopy time >15 min (OR 2.7, 95% CI: 1.1-7.0, P = 0.045), and procedure time >120 min (OR 2.8, 95% CI 1.1-7.3, P=0.037). Patient age, access age, days since last dialysis session, dialysis access volume, thrombectomy device type and heparin dose were not predictive of post-thrombectomy hyperkalemia.
Conclusions
Procedural complexity, represented in this study using proxy variables of contrast volume, fluoroscopy time, and procedure time, was predictive of new or worsening hyperkalemia after dialysis access thrombectomy. Higher prevalence of hyperkalemia was also seen in patients with hybrid accesses.