Degree and duration of hypokalemia associated with peritonitis in patients undergoing peritoneal dialysis

Liu, Danyang; Lin, Yanqun; Gong, Nirong; Xiao, Zhiwen; Zhang, Fen; Zhong, Xiaohong; Yi, Zhixiu; Cong, Yang; Zhang, Guangqing; Ai, Jun

doi:10.1111/ijcp.14188

Cited by 18 publications

(15 citation statements)

References 30 publications

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“…99 In addition to the degree of hypokalaemia, the duration of hypokalaemia was associated with the risk of peritonitis in PD patients. 100 Although there is no compelling evidence that treatment of hypokalaemia, constipation or gastroenteritis mitigates the risk of peritonitis, such problems, which are common in the PD setting, merit treatment in their own right. Based on previous observational and mechanistic studies of hypokalaemia in PD studies, the main contributory factor of hypokalaemia is low dietary potassium intake, rather than increased potassium excretion or intracellular shift.…”

Section: Prevention Of Peritonitismentioning

confidence: 99%

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

et al. 2022

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Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.

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Section: Prevention Of Peritonitismentioning

confidence: 99%

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

et al. 2022

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“…Electrolyte imbalance [25] is also commonly observed along with volume depletion and malnourishment due to peritonitis. Hypercalcemia [26], hypomagnesemia [25], hypokalemia [27,28], hypophosphatemia [29], and hypoalbuminemia [30] are also observed to occur in peritonitis patients and are key indices of frailty and sarcopenia. The bowel ileus caused by hypokalemia [31] may contribute to the overgrowth of intestinal microbiota [32], trigger bacterial penetration through the bowel wall, and cause repetitive peritonitis.…”

Section: Discussionmentioning

confidence: 99%

Rescue plan for CAPD peritonitis: Using ultrasonography as a guide on when to remove the catheter

Lumlertgul,

Tinroongroj,

Lumlertgul

et al. 2023

Ther Apher Dial

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IntroductionUltrasound has been found to facilitate early identification of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).MethodsA retrospective analysis was carried out to evaluate the effectiveness of ultrasonography‐guided removal of the Tenckhoff catheter in reducing complications like a shift to hemodialysis or death in CAPD patients.ResultsThe “peritonitis rescue plan” supported timely decision‐making for the removal of the infected catheter and resulted in a lower peritonitis episode per patient per month ratio (from 1:36 to 1:122) in 2021, a lower death rate (from 19% to 6.6%) and lower incidences of shifts to hemodialysis (from 2%–9% to 0%) as compared to that before the implementation of the plan in 2019.ConclusionThe implementation of the “peritonitis rescue plan” and the removal of the infected catheter within 3 days of peritonitis being detected was successful in improving the standard of care for patients undergoing CAPD.

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“…Ischemia, hypoxia, acidosis and inflammatory mediators collectively induce necrosis of epithelial cells, impair the intestinal mucosal barrier, increase intestinal permeability, and cause bacterial and endotoxin translocation [ 4 ]. Previous clinical studies have observed that PD patients with hypokalemia have a high prevalence of peritonitis [ 13 ]. The mechanisms for the increased risk of peritonitis caused by LK is speculated to be associated with malnutrition, impaired immune function and decreased intestinal motility [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hypokalemia, defined as potassium concentration < 3.5 mmol/l, affects 1–3% of the general population and patients with chronic kidney disease, and is more common (5–22%) among persons undergoing peritoneal dialysis (PD) [ 11 ], consequence of insufficient potassium intake and use of glucose dialysate. Peritonitis is a common and serious complication of PD [ 12 ] and patients with hypokalemia have a higher risk of PD-related peritonitis [ 13 ], but potential mechanisms for this phenomenon are not clear.…”

Section: Introductionmentioning

confidence: 99%

Low potassium disrupt intestinal barrier and result in bacterial translocation

Huang

Fan

et al. 2022

J Transl Med

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Background Bacterial translocation was observed in critical illness and patients with chronic diseases such as liver cirrhosis and chronic kidney disease (CKD). Hypokalemia is a common complication in these diseases. Whether low potassium diet may increase intestinal permeability and result in bacterial translocation lack of evidence. The present study was aimed to investigate the potential effects of LK on intestinal permeability. Methods Grade 8-week-old male Bal B/C mice were randomly placed either on a normal potassium (NK) mouse chow or a low potassium (LK) diet for 28 days. Intestinal permeability and expression of tight junction proteins were compared between the two groups. Results Compared with the NK group, the mice in LK group had significantly lower serum potassium level, increased levels of plasmas endotoxin and plasma d-lactate. The bacterial translocation was higher and in occurred mainly in mesenteric lymph nodes (MLN), liver and spleen. The pathologic change of small intestine was obvious with thinner villus lamina propria, shorter crypt depth and thinner intestinal wall. Slight increases in the expression of proteins and mRNA levels of both claudin-1 and claudin-2 were observed in LK group. Conclusions Low potassium diet could increase intestinal permeability and thereby lead to bacterial translocation, which was suspected to result from impaired intestinal epithelial barrier and biological barrier.

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Degree and duration of hypokalemia associated with peritonitis in patients undergoing peritoneal dialysis

Cited by 18 publications

References 30 publications

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

Rescue plan for CAPD peritonitis: Using ultrasonography as a guide on when to remove the catheter

Low potassium disrupt intestinal barrier and result in bacterial translocation

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