Dialysate and Serum Potassium in Hemodialysis

Hung, Adriana M.; Hakim, Raymond M.

doi:10.1053/j.ajkd.2015.02.322

Cited by 42 publications

(42 citation statements)

References 36 publications

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“…Despite substantial improvement in the mean lifespan of patients receiving maintenance hemodialysis [28] , sudden death, most of which is thought be arrhythmic in nature, remains a major threat [29,30] . Accordingly, previous studies have attempted to link hyperkalemia to sudden cardiac death directly [13][14][15] or circumstantially, but compellingly, via the interdialytic interval [8,31] .…”

Section: Discussionmentioning

confidence: 99%

Serum Potassium Levels and Mortality in Hemodialysis Patients: A Retrospective Cohort Study

Yusuf

Singh³

et al. 2016

Am J Nephrol

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Background: Hyperkalemia is common in patients receiving maintenance hemodialysis. However, few studies have examined the association between serum potassium level and mortality. Methods: This study used annual cohorts of hemodialysis patients during 2007-2010. To determine hyperkalemia prevalence, monthly hyperkalemia was defined as serum potassium level ≥5.5 mEq/l; prevalence was calculated as a ratio of hyperkalemia episodes to follow-up time, reported separately by long and short interdialytic interval. To determine the impact of hyperkalemia on mortality, patients in the 2010 cohort were followed from first potassium measurement until death or a censoring event; hyperkalemia was defined, sequentially, by potassium levels 5.5-6.0 mEq/l at 0.1 mEq/l intervals. Time-dependent Cox proportional hazards modeling was used to estimate the association between hyperkalemia and mortality. Results: The 4 annual cohorts ranged from 28,774 to 36,888 patients. Mean age was approximately 63 years, about 56% were men, 51% were white and 44% had end-stage renal disease caused by diabetes. Hyperkalemia prevalence was consistently estimated at 16.3-16.8 events per 100 patient-months. Prevalence on the day after the long interdialytic interval was 2.0-2.4 times as high as on the day after the short interval. Hyperkalemia, when defined as serum potassium ≥5.7 mEq/l, was associated with all-cause mortality (adjusted hazards ratio (AHR) 1.13, 95% CI 1.01-1.28, p = 0.037, vs. <5.7 mEq/l) after adjustment. AHRs increased progressively as the hyperkalemia threshold increased, reaching 1.37 (95% CI 1.16-1.62, p < 0.0001) for ≥6.0 mEq/l. Conclusions: The long interdialytic interval was associated with increased likelihood of hyperkalemia. Hyperkalemia was associated with all-cause mortality beginning at serum potassium ≥5.7 mEq/l; mortality risk estimates increased ordinally through ≥6.0 mEq/l, suggesting a threshold at which serum potassium becomes substantially more dangerous.

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Section: Discussionmentioning

confidence: 99%

Serum Potassium Levels and Mortality in Hemodialysis Patients: A Retrospective Cohort Study

Yusuf

Singh³

et al. 2016

Am J Nephrol

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“…Yüksek bikarbonat içerikli diyalizat ile hemodiyaliz tedavisi sonrası metabolik alkaloza bağlı hipokalemi, hipokalsemi ve aritmi riskinde artış görülmektedir (12). Özellikle yüksek bikarbonat içerikli diyalizat ile diyaliz esnasında serum bikarbonat seviyelerinde hızlı değişimlere bağlı olarak potasyum hücre dışından hücre içine geçer ve serum potasyum seviyelerinde hızlı düşüşler görülebilir.…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisiunclassified

Hemodiyaliz Hastalarında İki Farklı Bikarbonat İçerikli Diyalizat Kullanımının Asidoz Kontrolüne Etkisi

Tonbul¹,

Selçuk²,

Türkmen³

et al. 2017

Turk Neph Dial Transpl

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ÖZAmAç: Hemodiyaliz hastalarında kronik bir metabolik asidoz eğilimi söz konusudur. Yüksek olgu sayılı çalışmalarda diyaliz öncesi serum bikarbonat konsantrasyonu ile mortalite arasında ilişki saptanmıştır. Çalışmamızda 32 ve 36 mmol/L bikarbonat içerikli diyaliz solüsyonu kullanımının asidoz kontrolüne etkisi araştırıldı. Gereç ve YÖnTemler:Bir merkezde haftada üç kez hemodiyalize giren 91 (43E,48K) hastaya ilk altı ay 32 mmol/L diyalizat, ikinci altı ayda aynı hastalara 36 mmol/L bikarbonat diyalizat kullanılmaya başlandı ve diyaliz öncesi ve sonrası plazma bikarbonat düzeyleri karşılaştırıldı.BulGulAr: İlk altı ayda ortalama bikarbonat düzeyi 20,55±2,55 mmol/L olup sadece 30 hastada bikarbonat düzeyi 22 mmol/L ve üzerindeydi. İkinci altı aylık dönemde ise ortalama bikarbonat düzeyi 23,59±3,3 mmol/L olup hedef düzeylerdeydi. Ancak 19 hastada diyaliz sonu ortalama bikarbonat düzeyi 30 mmol/L'nin üzerinde bulundu. Prediyaliz asidozu olan hastaların ortalama interdiyalitik kilo artışı 2,8±0,5 kg olup, asidozu olmayan gruptan daha yüksekti (p<0,05). Prediyaliz üre, Kt/V, albumin, potasyum ve CRP düzeyleri bakımından iki periyot arasında anlamlı farklılık yoktu.SOnuç: 36 mmol/L bikarbonat içeren diyaliz solüsyonu kullanımı ile asidoz kontrolü daha iyi yapılmakta ancak hastaların yaklaşık yüzde yirmisinde diyaliz sonunda ciddi metabolik alkaloz gelişmektedir. Bu durum aritmiyi tetikleyebilir. Bu nedenle aritmisi olan veya metabolik alkaloza eğilimi olan hastalarda yüksek bikarbonatlı solüsyon kullanımında bikarbonat içeriğinin ayarlanmasının gerektiğini düşünmekteyiz.AnAHTAr SÖZcükler: Hemodiyaliz, Bikarbonat, Metabolik asidoz ABSTrAcT OBJecTIVe: In hemodialysis patients; there is a continuing tendency to metabolic acidosis. In studies, the relationship between serum bicarbonate concentration and dialysis mortality has been determined. In our study, the effect of 32 and 36 mmol/L bicarbonate-containing dialysis solution on acidosis control was investigated. mATerIAl and meTHODS:In a hemodialysis clinic, a 32 mmol/L bicarbonate-containing dialysate was used in the first six months and a 36 mmol/L bicarbonate-containing dialysate was used in the second six months. The study was performed on 91 (43M/48F) patients. Plasma bicarbonate levels before and after dialysis were compared. reSulTS:In the first period, only 30 patients' bicarbonate levels were 22 mmol/L or more. In the second period, the mean bicarbonate level was 23.59±3.3 mmol/L. However, the level of bicarbonate after dialysis was above 30 mmol/L in 19 patients. In patients with predialysis acidosis, the interdialytic mean weight gain was higher than in the group without acidosis (p<0.05). There were no significant differences between the two periods in terms of predialysis urea, Kt/V, albumin, potassium and CRP levels.cOncluSIOn: Acidosis control is better with the use of a dialysis solution containing 36 mmol/L bicarbonate. But at the end of dialysis, severe metabolic alkalosis developed on approximately twenty percent of patients. This situation can trigger...

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“…In a hemodialysis patient, potassium intake is recommended to be <60 mmol/day, or 420 mmol/week. A typical hemodialysis session removes 70–100 mmol, or 210–300 mmol/week . Most of the potassium removal during hemodialysis is diffusive, but 15% is via ultrafiltration .…”

Section: Optimizing Dialysate Potassiummentioning

confidence: 99%

“…The kinetics of potassium in thrice weekly HD must be understood to arrive at a plan for an optimal dialysate potassium prescription . First, HD removes potassium from the extracellular compartment, but 98% of potassium is in the intracellular space.…”

Section: Optimizing Dialysate Potassiummentioning

confidence: 99%

“…The recent reconsideration of hypokalemia is based on recognition that sudden cardiac death (SCD) secondary to arrhythmia is the most common cause of mortality in dialysis populations. The rate of sudden cardiac arrest (SCA) is 30 times greater than for individuals in the general population . The 30 day survival after SCA is 19%, and 1 year survival is only 9% …”

Section: Introductionmentioning

confidence: 99%

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Optimizing dialysate potassium

Lee

Mendelssohn

2016

Hemodialysis International

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Potassium shifts in thrice weekly HD patients are likely a reversible cause of arrhythmia and sudden cardiac death. In general, a dialysate potassium <2.0 mmol/L should be avoided, and many patients with dialysate potassium of 2 mmol/L could safely be adjusted upwards. The ideal predialysis serum potassium should be around 5.0 mmol/L. Trends in serum potassium and not single values, should inform chronic changes of dialysate potassium prescription. Atypical values should be dealt with as a one off, but should not lead to chronic bath changes. Referral to a renal dietician for counseling to limit dietary potassium intake is vital to prevent recurrence of these atypical episodes. Finally, facilities should develop and implement a formal and reliable way to alert the physician about possible potassium bath mismatching. This facility level approach works best if a policy is developed and endorsed by all involved stakeholders.

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Dialysate and Serum Potassium in Hemodialysis

Cited by 42 publications

References 36 publications

Serum Potassium Levels and Mortality in Hemodialysis Patients: A Retrospective Cohort Study

Serum Potassium Levels and Mortality in Hemodialysis Patients: A Retrospective Cohort Study

Hemodiyaliz Hastalarında İki Farklı Bikarbonat İçerikli Diyalizat Kullanımının Asidoz Kontrolüne Etkisi

Optimizing dialysate potassium

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