Yonsei Med J.  2021 Apr;62(4):315-324. 10.3349/ymj.2021.62.4.315.

Different Seasonal Variations of Potassium in Hemodialysis Patients with High Longitudinal Potassium Levels: A Multicenter Cohort Study Using DialysisNet

  • 1Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
  • 2Department of Nephrology, Changwon Fatima Hospital, Changwon, Korea.
  • 3Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
  • 5Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea.
  • 6Department of Biomedical Informatics (SNUBI), Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Korea.
  • 7Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.


To determine seasonal variations in serum potassium levels among hemodialysis patients.
Materials and Methods
This was a multicenter cohort study of patients whounderwent hemodialysis and were registered in DialysisNet at our four associated general hospitals between January and December 2016. Month-to-month potassium variability was quantified as SD/√{n/(n-1)}, and a non-hierarchical method was used to cluster groups according to potassium trajectories. Seasonal variations in potassium levels were analyzed using a cosinor analysis.
The analysis was performed on 279 patients with a mean potassium level of 5.08±0.58 mmol/L. After clustering, 52.3% (n=146) of patients were included in the moderate group (K+ , 4.6±0.4 mmol/L) and 47.7% (n=133) in the high group (K+ , 5.6±0.4 mmol/L). The mean potassium level peaked in January in the moderate group (4.83±0.74 mmol/L) and in August in the high group (5.51±0.70 mmol/L). In the high potassium group, potassium levels were significantly higher in summer than in autumn (p<0.001) and spring (p=0.007). Month-to-month potassium variability was greater in the high group than in the moderate group (0.59±0.19 mmol/L vs. 0.52±0.21 mmol/L, respectively, p=0.012). Compared to patients in the first quartile of potassium variability (≤0.395 mmol/L), those with higher variability (2nd–4th quartiles) were 2.8–4.2 fold more likely to be in the high potassium group.
Different seasonal patterns of serum potassium were identified in the moderate and high potassium groups, with potassium levels being significantly higher in the summer season in the high potassium group and in winter for the moderate potassium group.


End-stage renal disease; hemodialysis; potassium; seasonal variation
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