Prescriptions of dialysate potassium concentration during short daily or long nocturnal (high dose) hemodialysis

Leypoldt, John K.; Agar, Baris U.; Bernardo, Angelito; Culleton, Bruce F.

doi:10.1111/hdi.12331

Cited by 6 publications

(7 citation statements)

References 24 publications

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“…We conclude that potassium kinetics during hemodialysis can be described using a pseudo one‐compartment model. This model has potential to assist in the prescription of dialysate potassium concentration during more frequent and long nocturnal (high dose) hemodialysis; preliminary work toward this goal has been recently completed …”

Section: Discussionmentioning

confidence: 99%

Potassium kinetics during hemodialysis

Agar

Culleton

Fluck

et al. 2014

Hemodialysis International

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Hyperkalemia in hemodialysis patients is associated with high mortality, but prescription of low dialysate potassium concentrations to decrease serum potassium levels is associated with a high incidence of sudden cardiac arrest or sudden death. Improved clinical outcomes for these patients may be possible if rapid and substantial intradialysis decreases in serum potassium concentration can be avoided while maintaining adequate potassium removal. Data from kinetic modeling sessions during the HEMO Study of the dependence of serum potassium concentration on time during hemodialysis treatments and 30 minutes postdialysis were evaluated using a pseudo one-compartment model. Kinetic estimates of potassium mobilization clearance (K(M)) and predialysis central distribution volume (V(pre)) were determined in 551 hemodialysis patients. The studied patients were 58.8 ± 14.4 years of age with predialysis body weight of 72.1 ± 15.1 kg; 306 (55.4%) of the patients were female and 337 (61.2%) were black. K(M) and V(pre) for all patients were non-normally distributed with values of 158 (111, 235) (median [interquartile range]) mL/min and 15.6 (11.4, 22.8) L, respectively. K(M) was independent of dialysate potassium concentration (P > 0.2), but V(pre) was lower at higher dialysate potassium concentration (R = -0.188, P < 0.001). For patients with dialysate potassium concentration between 1.6 and 2.5 mEq/L (N = 437), multiple linear regression of K(M) and V(pre) demonstrated positive association with predialysis body weight and negative association with predialysis serum potassium concentration. Potassium kinetics during hemodialysis can be described using a pseudo one-compartment model.

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Section: Discussionmentioning

confidence: 99%

Potassium kinetics during hemodialysis

Agar

Culleton

Fluck

et al. 2014

Hemodialysis International

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“…Similarly, a pseudo-one-compartment model for phosphorus has been previously shown to be unable to exactly describe the changes in solute concentration throughout the entire interdialytic interval. 17 Yet, a pseudo-one-compartment model can evaluate the rate of solute generation during the interdialytic interval and thereby predict changes in the predialytic concentration of phosphorus 17,18 or potassium 19 after altering the HD Figure 1. A schematic description of the H + mobilization model.…”

Section: H + Mobilization Model Is a Pseudo-onecompartment Modelmentioning

confidence: 99%

Acid–base kinetics during hemodialysis using bicarbonate and lactate as dialysate buffer bases based on the H⁺mobilization model

et al. 2020

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Background: The H+ mobilization model has been recently reported to accurately describe intradialytic kinetics of plasma bicarbonate concentration; however, the ability of this model to predict changing bicarbonate kinetics after altering the hemodialysis treatment prescription is unclear. Methods: We considered the H+ mobilization model as a pseudo-one-compartment model and showed theoretically that it can be used to determine the acid generation (or production) rate for hemodialysis patients at steady state. It was then demonstrated how changes in predialytic, intradialytic, and immediate postdialytic plasma bicarbonate (or total carbon dioxide) concentrations can be calculated after altering the hemodialysis treatment prescription. Results: Example calculations showed that the H+ mobilization model when considered as a pseudo-one-compartment model predicted increases or decreases in plasma total carbon dioxide concentrations throughout the entire treatment when the dialysate bicarbonate concentration is increased or decreased, respectively, during conventional thrice weekly hemodialysis treatments. It was further shown that this model allowed prediction of the change in plasma total carbon dioxide concentration after transfer of patients from conventional thrice weekly to daily hemodialysis using both bicarbonate and lactate as dialysate buffer bases. Conclusion: The H+ mobilization model can predict changes in plasma bicarbonate or total carbon dioxide concentration during hemodialysis after altering the hemodialysis treatment prescription.

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“…It has been previously reported [20], and confirmed by theoretical models [21], that intradialytic reductions in serum potassium concentration are smaller during daily HD than thrice-weekly ICHD; however, none of those reports considered daily HD prescriptions at low dialysate flow rates. Data collected during the FREEDOM Study did not include measurements of postdialysis potassium concentrations; thus, the current study cannot empirically confirm that similar results will pertain to daily HD at low dialysate flow rates.…”

Section: Discussionmentioning

confidence: 99%

“…The current report describes the effect of dialysate potassium and lactate concentrations on serum concentrations of potassium and bicarbonate after transfer from ICHD to daily HD at low dialysate flow rates. With respect to potassium, prior clinical experience [19, 20] and theoretical models [21] have reported minimal changes in serum potassium concentration after transfer from ICHD to daily HD; however, none of the those reports were for patients treated with daily HD at low dialysate flow rates. Clinical experience reporting serum potassium concentrations in patients treated by daily HD at low dialysate flow rates have been previously reported in two studies.…”

Section: Discussionmentioning

confidence: 99%

Effect of dialysate potassium and lactate on serum potassium and bicarbonate concentrations during daily hemodialysis at low dialysate flow rates

Leypoldt¹,

Kraus²,

Jaber

et al. 2019

BMC Nephrol

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Background Observational studies of hemodialysis patients treated thrice weekly have shown that serum and dialysate potassium and bicarbonate concentrations are associated with patient outcomes. The effect of more frequent hemodialysis on serum potassium and bicarbonate concentrations has rarely been studied, especially for treatments at low dialysate flow rate. Methods These post-hoc analyses evaluated data from patients who transferred from in-center hemodialysis (HD) to daily HD at low dialysate flow rates during the FREEDOM Study. The primary outcomes were the change in predialysis serum potassium and bicarbonate concentrations after transfer from in-center HD (mean during the last 3 months) to daily HD (mean during the first 3 months). Results After transfer from in-center HD to daily HD (data from 345 patients, 51 ± 15 years of age, mean ± standard deviation), predialysis serum potassium decreased ( P < 0.001) by approximately 0.4 mEq/L when dialysate potassium concentration during daily HD was 1 mEq/L; no change occurred when dialysate potassium concentration during daily HD was 2 mEq/L. After transfer from in-center HD to daily HD (data from 284 patients, 51 ± 15 years of age), predialysis serum bicarbonate concentration decreased ( P = 0.0022) by 1.0 ± 3.3 mEq/L when dialysate lactate concentration was 40 mEq/L but increased ( P < 0.001) by 2.5 ± 3.5 mEq/L when dialysate lactate concentration was 45 mEq/L. These relationships were dependent on serum potassium and bicarbonate concentrations during in-center HD. Conclusions Control of serum potassium and bicarbonate concentrations during daily HD at low dialysate flow rates is readily achievable; the choice of dialysate potassium and lactate concentration can be informed when transfer is from in-center HD to daily HD. Electronic supplementary material The online version of this article (10.1186/s12882-019-1450-7) contains supplementary material, which is available to authorized users.

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Prescriptions of dialysate potassium concentration during short daily or long nocturnal (high dose) hemodialysis

Cited by 6 publications

References 24 publications

Potassium kinetics during hemodialysis

Potassium kinetics during hemodialysis

Acid–base kinetics during hemodialysis using bicarbonate and lactate as dialysate buffer bases based on the H⁺mobilization model

Effect of dialysate potassium and lactate on serum potassium and bicarbonate concentrations during daily hemodialysis at low dialysate flow rates

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Prescriptions of dialysate potassium concentration during short daily or long nocturnal (high dose) hemodialysis

Cited by 6 publications

References 24 publications

Potassium kinetics during hemodialysis

Potassium kinetics during hemodialysis

Acid–base kinetics during hemodialysis using bicarbonate and lactate as dialysate buffer bases based on the H+mobilization model

Effect of dialysate potassium and lactate on serum potassium and bicarbonate concentrations during daily hemodialysis at low dialysate flow rates

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Acid–base kinetics during hemodialysis using bicarbonate and lactate as dialysate buffer bases based on the H⁺mobilization model