Background: Hyperkalemia is a common medical emergency that may result in serious cardiac arrhythmias. Standard therapy with insulin plus glucose reliably lowers the serum potassium concentration ([K⁺]) but carries the risk of hypoglycemia. This study examined whether an intravenous glucose-only bolus lowers serum [K⁺] in stable, nondiabetic, hyperkalemic patients and compared this intervention with insulin-plus-glucose therapy. Methods: A randomized, crossover study was conducted in 10 chronic hemodialysis patients who were prone to hyperkalemia. Administration of 10 units of insulin with 100 ml of 50% glucose (50 g) was compared with the administration of 100 ml of 50% glucose only. Serum [K⁺] was measured up to 60 min. Patients were monitored for hypoglycemia and EKG changes. Results: Baseline serum [K⁺] was 6.01 ± 0.87 and 6.23 ± 1.20 mmol/l in the insulin and glucose-only groups, respectively (p = 0.45). At 60 min, the glucose-only group had a fall in [K⁺] of 0.50 ± 0.31 mmol/l (p < 0.001). In the insulin group, there was a fall of 0.83 ± 0.53 mmol/l at 60 min (p < 0.001) and a lower serum [K⁺] at that time compared to the glucose-only group (5.18 ± 0.76 vs. 5.73 ± 1.12 mmol/l, respectively; p = 0.01). In the glucose-only group, the glucose area under the curve (AUC) was greater and the insulin AUC was smaller. Two patients in the insulin group developed hypoglycemia. Conclusion: Infusion of a glucose-only bolus caused a clinically significant decrease in serum [K⁺] without any episodes of hypoglycemia.

BackgroundIntradialytic hypertension (IDH) increases morbidity and mortality. The prevalence in South Africa is unknown. The pathogenesis is unclear, but it has been suggested that IDH may be due to subclinical fluid overload. The objective of this study was to determine the prevalence of IDH and to evaluate its association with fluid overload using bioimpedance spectroscopy (BIS).MethodsA cross-sectional study involving 190 chronic haemodialysis patients in the Western Cape province of South Africa was conducted between January 2013 and May 2014. IDH was defined as a >10 mmHg increase in systolic blood pressure in at least four of six prior consecutive haemodialysis sessions.ResultsThe prevalence of IDH was 28.4% (n = 54). There was a trend towards pre-dialysis overhydration in the IDH group when compared with controls {2.6 L [95% confidence interval (CI) 1.7–3.4] versus 1.8 L [95% CI 1.4–2.1], respectively; P = 0.06} as measured by BIS, but no difference in mean ultrafiltration (UF) volume (2.4 versus 2.6 L; P = 0.30). A trend towards greater use of antihypertensive drugs was noted in the IDH group [2.5 drugs (95% CI 2.15–2.87) versus 2.1 (95% CI 1.82–2.30); P = 0.05]. More participants in the IDH group received calcium channel blockers (54 versus 36; P = 0.03).ConclusionsThe prevalence of IDH in our treatment centres is much higher than previously reported. Subclinical fluid overload may be a major contributing factor to the mechanism of this condition. The use of BIS identifies patients who may benefit from additional UF.

Background The prevalence and incidence of hyperkalaemia, a potassium abnormality which can potentially have life-threatening consequences, is unclear. Objective To provide the most comprehensive overview of the epidemiology of hyperkalaemia to date both within the general population, across different continents, in different healthcare settings and within pre-specified sub-groups. Data Sources Embase and MEDLINE were searched from database inception to 2nd February 2021 using the Ovid SP platform. Relevant congress proceedings from 2018-2020 were also reviewed for inclusion. There was no language constraint applied. Study Selection Observational studies from any time period and language reporting prevalence or incidence of hyperkalaemia within both adult and paediatric populations. Data Extraction and Synthesis Four investigators independently screened abstracts and assessed study quality of those meeting the pre-determined inclusion/exclusion criteria. Data extraction was conducted by the lead author with oversight from the senior author and data was pooled using a random-effects model. Main Outcome(s) and Measure(s) The measures assessed were the prevalence and incidence of hyperkalaemia. Prevalence was reported as a percentage, whilst incidence was reported as the rate per 100 person years. Results In total, 542 articles were included from an initial search of 14,112 articles. Across all adult studies we report prevalence of hyperkalaemia (by any definition/threshold) of 6.3% (95% CI: 5.8-6.8%), with an incidence of hyperkalaemia in the adult population of 2.8 (95% CI: 2.3-3.3) cases per 100 person years. Prevalence within the general population was 1.3% (95% CI: 1.0-1.8%) whilst incidence was 0.4 (95% CI: 0.2-0.8) cases per 100 person years. There was variation by sex with prevalence of 6.3% (95% CI: 4.9-8.0%) in males and 5.1% (95% CI: 4.0-6.6%) in females. Prevalence also varied according to the definition/threshold of hyperkalaemia used: &gt;5mmol/L - 8.0% (7.2-8.9), ≥ 5.5mmol/L - 5.9% (3.5-10.0) and ≥ 6.0mmol/L – 1.0% (0.8-1.4) and hyperkalaemia (by any definition/threshold) was highest amongst patients with end-stage kidney disease 21.5% (18.3-25.3), kidney transplant patients 21.8% (16.1-29.5) and patients with acute kidney injury 24.3% (19.3-30.7). Conclusions This novel review provides a comprehensive and valuable resource on the prevalence and incidence of hyperkalaemia to better inform clinicians, healthcare providers and health policy makers on the burden of hyperkalaemia across different healthcare settings, patient populations and continents.