Abnormalities of serum potassium concentration in dialysis-associated hyperglycemia and their correction with insulin: review of published reports

Abstract

The main difference between dialysis-associated hyperglycemia (DH) and diabetic ketoacidosis (DKA) or nonketotic hyperglycemia (NKH) occurring in patients with preserved renal function is the absence of osmotic diuresis in DH, which eliminates the need for large fluid and solute (including potassium) replacement. We analyzed published reports of serum potassium (K(+)) abnormalities and their treatment in DH. Hyperkalemia was often present at presentation of DH with higher frequency and severity than in hyperglycemic syndromes in patients with preserved renal function. The frequency and severity of hyperkalemia were higher in DH episodes with DKA than those with NKH in both hemodialysis and peritoneal dialysis. For DKA, the frequency and severity of hyperkalemia were similar in hemodialysis and peritoneal dialysis. For NKH, hyperkalemia was more severe and frequent in hemodialysis than in peritoneal dialysis. Insulin infusion corrected the hyperkalemia of DH in most cases. Additional measures for the management of hyperkalemia or modest potassium infusions for hypokalemia were needed in a few DH episodes. The predictors of the decrease in serum K(+) during treatment of DH with insulin included the starting serum K(+) level, the decreases in serum values of glucose concentration and tonicity, and the increase in serum total carbon dioxide level. DH represents a risk factor for hyperkalemia. Insulin infusion is the only treatment for hyperkalemia usually required.

Abnormalities of serum potassium concentration in dialysis-associated hyperglycemia and their correction with insulin: a unique clinical/physiologic exercise in internal potassium balance

“…This review presents an interpretation, based upon the actions of relevant regulators of internal potassium balance, of the cardinal findings in our review of published studies on serum K ? in DH and its treatment [9].…”

Lesson of the month 1: Diabetic ketoacidosis in established renal failure

“…It has been reported that dialysis patients with hyperglycaemia have an increased frequency and severity of hyperkalaemia in comparison to patients with DKA and preserved renal function. 7 A mainstay of DKA treatment is insulin; this improves both ketonaemia and hyperglycaemia. 5,6 Correction of ketonaemia usually requires ongoing insulin infusion even after normalisation of blood glucose.…”

Hyperkalemia in two patients with diabetes mallitus and chronic kidney disease. Role of disrupted internal potassium balance

“…Consequently, the degree of hypertonicity in dialysis-associated hyperglycemia is predicted by Katz's formula with remarkable accuracy [18]. Urinary potassium losses are also limited, and hyperkalemia is frequent in hyperglycemic episodes occurring in this setting [19][20]. The degree of hyperglycemic hyperkalemia in dialysis patients is higher when ketoacidosis is present [19,21].…”

“…Ketoacidosis contributes to the development of hyperglycemic hyperkalemia by affecting the function of several transport pathways in the cell membrane [22]. Insulin is the only required treatment for both hyperglycemia and hyperkalemia in patients with ESRD, although additional measures may be necessary for extreme cases of hyperkalemia [19][20]23].…”