Dialysate Potassium, Serum Potassium, Mortality, and Arrhythmia Events in Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Karaboyas, Angelo; Zee, Jarcy; Brunelli, Steven M.; Usvyat, Len; Weiner, Daniel E.; Maddux, Franklin W.; Nissenson, Allen R.; Jadoul, Michel; Locatelli, Francesco; Winkelmayer, Wolfgang C.; Port, Friedrich K.; Robinson, Bruce M.; Tentori, Francesca

doi:10.1053/j.ajkd.2016.09.015

Cited by 150 publications

(174 citation statements)

References 35 publications

Supporting

Mentioning

165

Contrasting

Unclassified

Order By: Relevance

“…As such, their clinical use is very common even in HD patients. However, data concerning the side effect of hyperkalemia in patients on regular HD are still controversial [16]. For this reason, we conducted this observational study with the aim of evaluating the pre HD serum K concentrations after the introduction of an ACEi or an ARB as part of standard antihypertensive therapy in prevalent anuric HD patients.…”

Section: Discussionmentioning

confidence: 99%

Use of Renin-Angiotensin System Blockers Increases Serum Potassium in Anuric Hemodialysis Patients

Movilli¹,

Camerini²,

Gaggia³

et al. 2018

Am J Nephrol

View full text Add to dashboard Cite

Background: Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are increasingly used in uremic patients (pts). However, their effect on serum potassium (sK) concentrations in anuric pts on chronic hemodialysis treatment (HD) is controversial. The aim of the study was to evaluate sK before and after the start of ACEi/ARB therapy. Methods: In the period 1/1/2015 – 31/12/2015, 112 out of 240 prevalent HD pts on thrice weekly HD treatment followed at our institution started the ACEi/ARB therapy. The mean age was 67 ± 14 years, 67/112 were men, dialysis vintage was 6–212 months. In the 3 months before (PRE; N° 36 HD sessions) and after (POST; N° 36 HD sessions) the start of ACEi/ARB therapy, the following variables were evaluated in pre dialysis after the long interdialysis interval: sK (mean of 12 determinations; mmol/L), maximum sK (maximum K value observed during observations; sKmax; mmol/L), serum sodium (sNa; mmol/L), pre dialysis systolic blood pressure (SBP; mm Hg) and diastolic blood pressure (DBP; mm Hg), body weight (BW; Kg), interdialytic weight gain (IWG; Kg), Kt/V, serum bicarbonate concentrations (sBic; mmol/L), protein catabolic rate (PCRn; g/KgBW/day). SBP, DBP, IWG are the mean of the 24 HD sessions. Out of 112 patients, 102 were on antihypertensive therapy. The duration of HD and blood and dialysate flow rates were kept constant. Data are expressed as mean ± SD. Student t test for paired and unpaired data for normally distributed variables, Mann-Whitney test for medians, χ² test for categorical data were employed to compare groups. A significant difference was defined as p < 0.05. Results: sK increased from 5.0 ± 0.4 mmol/L PRE to 5.7 ± 0.5 mmol/L POST (p < 0.0001). sKmax increased from 5.3 ± 0.5 mmol/L PRE to 6.2 ± 0.6 mmol/L POST (p < 0.0001). The percentage of pts with normal sK concentrations decreased from 82% PRE to 29% POST (p < 0.0001). Mild hyperkalemia increased from 18 to 52% (p < 0.001); in 31% of the patients, it was necessary to reduce the K dialysate concentration. None of the patients had severe hyperkalemia PRE, but 19% developed severe hyperkalemia POST (p < 0.0001) necessitating treatment withdrawal. Mean sK in these pts varied from 5.2 ± 0.3 mmol/L PRE to 6.5 ± 0.2 mmol/L at the moment of withdrawal (p < 0.0001) and sKmax from 5.5 ± mmol/L PRE to 6.9 ± 0.3 mmol/L (p< 0.0001). After withdrawal of ACEi/ARB, sK and sKmax concentrations decreased to basal levels within 1 month. There were no significant changes of BW, IWG, SBP, DBP, Na, Hb, Kt/V, sBic, and PCRn in both periods. Conclusions: ACEi/ARB therapy is associated with an increased risk of hyperkalemia in anuric hemodialysis patients. The proportion of patients with normal sK concentrations decreased from 82 to 29% and with mild hyperkalemia increased from 18 to 52%. Severe hyperkalemia necessitating the interruption of ACEi/ARB therapy developed in 19% of patients. This suggests great caution in the widest utilization of this class of drugs in HD patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Use of Renin-Angiotensin System Blockers Increases Serum Potassium in Anuric Hemodialysis Patients

Movilli¹,

Camerini²,

Gaggia³

et al. 2018

Am J Nephrol

View full text Add to dashboard Cite

show abstract

“…Perhaps more importantly, it was associated with shorter recovery time and lower risk for first hospitalization and mortality. The use of dialysate potassium concentrations <2.0 mEq/L may pose a significant risk for cardiac arrhythmia and sudden death . We are unaware of any previous descriptions of an association of dialysate potassium with prolonged recovery time.…”

Section: Introductionmentioning

confidence: 95%

Low dialysate potassium concentration is associated with prolonged recovery time

Harford

Gul

Cumber

et al. 2017

Hemodialysis International

View full text Add to dashboard Cite

Introduction: Modifiable hemodialysis treatment parameters may impact patient reported outcomes, including recovery time. Answers to the recovery question may predict the impact of treatment parameters on clinical outcomes and health related quality of life. However, the reliability of answers to the recovery question after consecutive and nonconsecutive dialysis treatments in diverse populations has not been established.Objective: To assess the reliability of this instrument and to determine if recovery time was associated with modifiable dialysis parameters, we conducted a quality assurance project in which we asked, "How long did it take you to recover from your last dialysis session?" after consecutive and nonconsecutive treatments. Methods:We asked patients the recovery question seven times. We computed polychoric correlations to assess within patient correlations. We used random intercept ordinal logistic regression models to test for associations of recovery time with patient variables. Results:We obtained answers to the recovery question in association with 1572 treatments in 364 patients. Recovery time was <2 hours in 52.1%; 2 to 7 hours in 20.9%; and >7 hours in 27.0% of treatments. Polychoric correlations demonstrated highly reliable responses within individual patients between consecutive and nonconsecutive treatments. Prolonged recovery was associated with a dialysate potassium of 1 vs. 2 mEq/L (odds ratio [OR] Conclusions: Responses to the recovery question were reliable and low dialysate potassium was associated with prolonged recovery.

show abstract

“…This disorder leads to complications in heart rhythm and finally heart failure. Therefore, it is well known as a risk factor for sudden death and mortality of patients under hemodialysis, and any education on adherence to low potassium level can be effective in decreasing this risk (19). Also, sodium, as one of the important extracellular fluid components, has a crucial role in creating serum osmolality.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Nutrition Education Program on Biochemical Parameters Among Patients With Chronic Kidney Disease Undergoing Hemodialysis

Jahanpeyma¹,

Makhdoomi²,

Sajadi³

2017

Crit Care Nurs J

View full text Add to dashboard Cite

Background: Nutrition is considered an important part of treatment in patients with chronic kidney disease (CKD). Therefore, poor nutrition leads to decreased life quality and increased complications of hemodialysis as well as mortality in these patients. This study aimed at investigating the effect of nutrition education program (NEP) on biochemical parameters among patients undergoing hemodialysis. Methods: This quasi-experimental study was conducted on 30 patients who referred to hemodialysis unit at Ayatollah Taleghani hospital in Urmia province, Iran. The sampling method was purposive. Data were collected through interviews and data collection instruments consisted of demographic questionnaires and checklist. In the pre-education stage, the demographic questionnaire was completed and a 2-month average of biochemical parameters (sodium, potassium, calcium, phosphor, blood urea nitrogen, and creatinine) were measured and recorded in the checklist by the researcher. Then, the patients received four 30-minute educational sessions on nutrition using learning assistant tools. Two months after the education program, the laboratory results were measured and recorded again by the researcher. Data analysis was performed using SPSS 14 and paired t test, and significance level was set at 0.05 (P < 0.5). Results:The findings revealed a significant decrease in sodium, potassium, calcium, blood urea nitrogen (P < 0.05), but no significant difference was found in the laboratory results of phosphor and creatinine (P < 0.05). Conclusions: The implementation of nutrition education program (NEP) for patients under hemodialysis can improve biochemical parameters as well as complications resulting from their imbalance. Therefore, this program is recommended for this group of patients.

show abstract

Dialysate Potassium, Serum Potassium, Mortality, and Arrhythmia Events in Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Cited by 150 publications

References 35 publications

Use of Renin-Angiotensin System Blockers Increases Serum Potassium in Anuric Hemodialysis Patients

Use of Renin-Angiotensin System Blockers Increases Serum Potassium in Anuric Hemodialysis Patients

Low dialysate potassium concentration is associated with prolonged recovery time

The Effect of Nutrition Education Program on Biochemical Parameters Among Patients With Chronic Kidney Disease Undergoing Hemodialysis

Contact Info

Product

Resources

About