Optimizing dialysate potassium

Abstract

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.

Dialysate potassium concentration: Should mass balance trump electrophysiology?

“…Since urinary excretion of potassium is lost or greatly reduced in ESKD patients, potassium mass balance must be maintained using a combination of dietary potassium restriction and dialytic removal. The goals of ideal dialytic management are to achieve an intradialytic negative potassium mass balance that equals the positive mass balance occurring between treatments so that both interdialytic hyperkalemia and intradialytic hypokalemia are prevented …”

“…The recommended daily potassium intake for hemodialysis patients is a restricted intake of about 60 mEq/day (420 mEq/week) . A typical dialysis treatment removes 70‐100 mEq (210‐300 mEq/week for thrice weekly hemodialysis patients) through a combination of diffusive and convective clearance.…”

“…With the extended treatment times, there was a slower rate of serum potassium fall, a 15% overall increase in total potassium removal, and an identical end‐of‐treatment serum potassium in 8 hour treatments compared to 4 hour treatments. However, the limitation of both these approaches is that they are less available and generally less desirable for patients and dialysis providers alike …”

“…The goals of ideal dialytic management are to achieve an intradialytic negative potassium mass balance that equals the positive mass balance occurring between treatments so that both interdialytic hyperkalemia and intradialytic hypokalemia are prevented. 4 The recommended daily potassium intake for hemodialysis patients is a restricted intake of about 60 mEq/day (420 mEq/week). 4 A typical dialysis treatment removes 70-100 mEq (210-300 mEq/ week for thrice weekly hemodialysis patients) through a combination of diffusive and convective clearance.…”

“…4 The recommended daily potassium intake for hemodialysis patients is a restricted intake of about 60 mEq/day (420 mEq/week). 4 A typical dialysis treatment removes 70-100 mEq (210-300 mEq/ week for thrice weekly hemodialysis patients) through a combination of diffusive and convective clearance. Therefore, assuming negligible urinary potassium clearance, some potassium elimination via the gastrointestinal tract is needed to maintain neutral potassium mass balance.…”