Association between hypokalemia, malnutrition and mortality in Peritoneal Dialysis patients

Vavruk, Ana Maria; Martins, Cristina; Nascimento, Marcelo Mazza do; Hayashi, Shirley Yumi; Riella, Miguel C.

doi:10.5935/0101-2800.20120024

Cited by 21 publications

(18 citation statements)

References 9 publications

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“…Spironolactone was safer among dialysis patients than nondialysis patients, since the kidneys account for only a small part of potassium metabolism, and most of the potassium is excreted by dialysis. This may be a great advantage when selecting it for PD patients who are constantly prone to hypokalemia …”

Section: Discussionmentioning

confidence: 99%

Effects of Spironolactone on Dialysis Patients With Refractory Hypertension: A Randomized Controlled Study

Zhang

et al. 2014

J of Clinical Hypertension

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The purpose of this study was to evaluate the effects of spironolactone on dialysis patients with refractory hypertension and possible adverse effects. This was a 12-week prospective, randomized, double-blind trial of 82 patients randomly assigned to 12-week treatment with 25 mg/d spironolactone or placebo as add-on therapy. Visits were scheduled at the start of treatment and after 12 weeks. Measurements of 24-hour ambulatory blood pressure (BP) monitoring and morning BP were performed. After 12 weeks, spironolactone significantly improved refractory hypertension. Average placebo-corrected morning BP was reduced by 16.7/7.6 mm Hg. Mean 24-hour ambulatory BP was reduced by 10.9/5.8 mm Hg. In contrast, serum aldosterone levels in the spironolactone group slightly increased and serum potassium levels insignificantly increased. This study has demonstrated that spironolactone (50 mg) safely and effectively reduces BP in patients with refractory hypertension undergoing dialysis.

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Section: Discussionmentioning

confidence: 99%

Effects of Spironolactone on Dialysis Patients With Refractory Hypertension: A Randomized Controlled Study

Zhang

et al. 2014

J of Clinical Hypertension

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“…Its etiology has been attributed to several different factors: some of them related to the underlying disease; others, to medical therapies, malnutrition and diets with low potassium intake 3 . Another explanation blames the transcelular distribution of potassium stimulated by insulin (in response to peritoneal glucose) 4 , loss of potassium through urine, sweat and peritoneum specially when the number of exchanges is high and residual kidney function is presented 5 .…”

Section: Introductionmentioning

confidence: 99%

Hypokalemia results of treatment for patients in peritoneal dialysis with spironolactone

Valencia

Iglesias

Álvarez

2015

Rev. Colomb. Nefrol.

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Objective: To determine whether a treatment with spironolactone can correct chronic idiopathic hypokalemia for patients with chronic kidney disease undergoing treatment with peritoneal dialysis. Design: Interventional study without control group. Patients:Patients with chronic kidney disease over 18 years old, undergoing treatment with peritoneal dialysis for over 1 year; with reported diuresis of less than 100 ml in 24 hours and in whom chronic idiopathic hypokalemia was diagnosed. Materials and methods:All patients were tested for known causes of hypokalemia; once these causes were discarded we initiated treatment with spironolactone with an initial dose of 25 mgs per day and a monthly increase of 25 mgs until a maximum dose of 200 mg per day. Serum potassium was measured monthly and dialyzed potassium was measured every 6 months.Results: 20 patients fulfilled the requirements for inclusion. Four patients (20%) developed hyperkalemia and had to stop the treatment. For the remaining 16 patients initial potassium of 2,84 was measured, 6 months later it was elevated to 3,40; 3,37 after 12 months; 3,58 after 18 months and 3,9 after 22 months, these values were statistically significant (p < 0,05). 12 episodes of peritonitis occurred for the 16 patients, representing an incidence of 1 episode per 19 patients month. The average dose of spironolactone used after 3 months was 65 mgs; 67 mgs after 6 months; 75 mgs after 12 months; 60 mgs after 18 months and 68 mgs after 22 months. In the 22 months follow up, 5 (25%) patients were with drawn for motives not related to therapy and 7 of the 16 (43.75%) patients passed away. Conclusions:Hypokalemia is a cause of great mortality for patients undergoing treatment with peritoneal dialysis; in addition to its own risks it also facilitates the development of peritonitis that requires additional therapeutic interventions. We suggest that could Spironolactone diminish the intestinal loss of potassium but may cause hyperkalemia so patients must be closely monitored.Key word: chronic kidney disease, peritoneal dialysis, and hypokalemia (fuente DeCS).Resultados del tratamiento de la hipopotasemia con espironolactona en paciente con enfermedad renal crónica en dialisis peritoneal Resumen Objetivo: Determinar si el tratamiento con espironolactona puede corregir la hipopotasemia crónica idiopá-tica de pacientes con enfermedad renal crónica (ERC) en tratamiento con diálisis peritoneal. Diseño 103Pacientes: Pacientes con ERC mayores de 18 años, quienes requirieron diálisis peritoneal por más de 1, quienes tenían una diuresis menor a 100 ml/24 horas, y en quienes se había diagnosticado hipopotasemia crónica idiopática. Materiales y metodos: Todos los pacientes fueron valorados para causas conocidas de hipopotasemia.Una vez que fueron descartadas se optó por iniciar tratamiento con espironolactona, a una dosis inicial de 25 mgs por día e incrementos mensuales de 25 mgs, hasta una dosis máxima de 200 mgs. El potasio sérico fue medido cada mes y el potasio del dializado cada 6 meses...

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“…Diversos estudos corroboram com esses achados (DE MORAES et al, 2014;OLIVEIRA et al, 2014;RAJAEEFARD et al, 2016;VAVRUK et al 2012, GONÇALVES et al, 2013 .…”

Section: Discussionunclassified

“…Diferentemente dos dados estudados em relação a tempo de acompanhamento, Vavruk et al (2012) encontrou o tempo médio de 3,6 anos em um centro de diálise de Curitiba (PR). E, em um estudo japonês, realizado em 2015 foi descrito tempo médio de seguimento de três anos (MARUYAMA et al, 2015).…”

Section: Discussionunclassified

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Aspectos epidemiológicos de pacientes com doença renal crônica em programa de diálise peritoneal: levantamento de 22 anos

Bezerra¹

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Association between hypokalemia, malnutrition and mortality in Peritoneal Dialysis patients

Abstract: Low levels of serum potassium were associated to lower survival in PD patients and it seems to be related to malnutrition.

Cited by 21 publications

References 9 publications

Effects of Spironolactone on Dialysis Patients With Refractory Hypertension: A Randomized Controlled Study

Effects of Spironolactone on Dialysis Patients With Refractory Hypertension: A Randomized Controlled Study

Hypokalemia results of treatment for patients in peritoneal dialysis with spironolactone

Aspectos epidemiológicos de pacientes com doença renal crônica em programa de diálise peritoneal: levantamento de 22 anos

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