The faster potassium-lowering effect of high dialysate bicarbonate concentrations in chronic haemodialysis patients

Heguilén, Ricardo; Sciurano, Claudia; Bellusci, Angel D; Fried, Paula; Mittelman, Graciela; Diez, Guillermo Rosa; Bernasconi, A.

doi:10.1093/ndt/gfh661

Cited by 83 publications

(73 citation statements)

References 15 publications

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“…[18][19][20] One study, published in 2003, was included in the prior review. 21 Therefore, we included in this updated review 5 new studies, [22][23][24][25][26] along with the 11 studies 21,[27][28][29][30][31][32][33][34][35][36] reviewed by Mahoney and associates 14 (Appendix 1, available at www .cmaj .ca /cgi /content /full /cmaj .100461 /DC1).…”

Section: Resultsmentioning

confidence: 99%

“…Five studies evaluated hemodialysis for the management of hyperkalemia 23,24,29,35,36 (Appendix 7, available at www .cmaj .ca /cgi/content/full/cmaj.100461/DC1). Lower potassium dialysate 35 and increased blood flow 36 were reported to decrease potassium to a greater extent, whereas the effect of bicarbonate dialysate on potassium reduction was inconclusive.…”

Section: Hemodialysismentioning

confidence: 99%

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Management of patients with acute hyperkalemia

Elliott¹,

Ronksley²,

Clase³

et al. 2010

Canadian Medical Association Journal

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A 72-year-old man presents to his family physician for follow-up of hypertension, reporting fatigue and generalized weakness. His medical history also includes peptic ulcer disease, type 2 diabetes mellitus and chronic kidney disease. The estimated glomerular filtration rate is 30 mL/min per 1.73 m 2 . His medications include metformin, lansoprazole, acetylsalicylic acid, hydrochlorothiazide and ramipril, the dose of which was increased two weeks earlier to address suboptimal blood pressure control. Blood work at the time of the current presentation shows that the serum potassium level is 6.7 (normal range 3.3-5.1) mmol/L from a nonhemolyzed sample. The patient's family physician refers him to the emergency department urgently. In the emergency department, the patient is hemodynamically stable, with blood pressure 124/70 mm Hg and heart rate 80 beats/min (regular). Repeat testing shows a potassium level of 6.9 mmol/L, and electrocardiography shows sinus rhythm with peaked T waves, prolonged PR interval (240 milliseconds) and a narrow QRS interval. This patient requires urgent treatment of hyperkalemia. What therapeutic options are available, and what is the evidence supporting their use? H yperkalemia is a common disorder, occurring both in the outpatient setting and in up to 10% of patients who have been admitted to hospital. [1][2][3][4] Underlying renal insufficiency and use of medications that disrupt potassium balance, such as angiotensin-converting enzyme inhibitors and potassium-sparing diuretics, are welldescribed risk factors. [4][5][6][7] Although mild hyperkalemia is often asymptomatic and easily treated, acute, severe hyperkalemia that is left untreated can result in fatal cardiac arrhythmias. [8][9][10] In addition to discontinuation of precipitants, steps in the management of acute hyperkalemia include protecting the heart from arrhythmias by administering calcium-based salts, 11 shifting potassium into the cells and enhancing elimination of potassium. Several treatment options have been proposed, particularly for shifting potassium into the cells, with differing onset and duration of action. 12 In addition, available studies conflict with respect to the efficacy of the various treatment options, which has led to differences in recommendations among practitioners and institutions. 5,13The level of potassium at which treatment should be initiated has not been established by evidence. However, we recommend initiating nonpharmacologic steps for management at levels above 5.5 mmol/L, with pharmacologic interventions as outlined in this review being instituted at levels of 6.0 mmol/L or greater.Given uncertainties regarding the optimal management of this condition, we undertook a review of randomized controlled trials of therapies for the management of acute hyperkalemia in the adult population. MethodsFor the current review, we updated a previously published systematic review on this topic, 14 using a similar search strategy and similar criteria for selecting studies for inclusion. We identified all po...

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Section: Resultsmentioning

confidence: 99%

Section: Hemodialysismentioning

confidence: 99%

Management of patients with acute hyperkalemia

Elliott¹,

Ronksley²,

Clase³

et al. 2010

Canadian Medical Association Journal

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“…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. Bu durum kardiyak aritmi gelişimine yol açabilir (13). Biz de benzer olarak 36 mmol/L bikarbonat içerikli diyalizat kullanılan dönemde potasyum seviyelerini 32 mmol/L bikarbonat içerikli diyalizat kullanılan döneme göre daha düşük bulduk (Tablo III).…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisiunclassified

“…Aynı zamanda serum bikarbonatından bağımsız olarak yüksek diyalizat bikarbonatı kullanımının kardiyovasküler ve tüm sebeplere bağlı ölümlerde artış ile ilişkili olduğu da gösterilmiştir (23). Bizim çalışmamızda da 36 mmol/L bikarbonat içerikli diyalizat kullanılan dönemde 19 hastada (%21), 32 mmol/L bikarbonatlı diyalizat kullanılan dönemde ise 4 hastada (%4.4) postdiyaliz alkaloz (HCO 3 ≥30 mmol/L) saptandı.…”

Section: Bikarbonat 32 Mmol/l (N=91)unclassified

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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“…Die Verwendung eines Blutgasanalysegeräts, das die Kaliumbestimmung erlaubt, kann eine Verzögerung der Diagnose verhindern. [9], einen hohen Blutfluss [10] oder eine hohe Bikarbonatkonzentration [11] im Dialysat verbessert werden. Erwä-gen Sie frühzeitig die Hämodialyse bei einer Hyperkalämie, die durch eine manifeste Niereninsuffizienz, ein oligurisches akutes Nierenversagen (Urinproduktion <400 ml/Tag) oder durch größeren Gewebeuntergang verursacht ist.…”

Section: Hyperkalämieunclassified