Disorders of Potassium Metabolism

Bourgoignie, Jacques J.; Oster, James R.; Pérez, Guido O.; Green, Dollie F.

doi:10.1007/978-1-4613-0689-4_4

Cited by 2 publications

(1 citation statement)

References 244 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Based on the rapid potassium flux hypothesis, it has been recommended that zero‐potassium dialysate never be used for the treatment of hyperkalemic patients, except perhaps in the presence of a life‐threatening arrhythmia or conduction abnormality . Instead, some suggest that one reduce the dialysate potassium concentration gradually during dialysis to reduce the risk of ventricular ectopy, and employ continuous electrocardiographic monitoring .…”

Section: Threat Of Rapid Fall In Plasma Potassium Levels During Dialysismentioning

confidence: 99%

Low Dialysate Potassium Concentration: An Overrated Risk Factor for Cardiac Arrhythmia?

Abuelo

2014

Seminars in Dialysis

View full text Add to dashboard Cite

Serum potassium concentrations rise with dietary potassium intake between dialysis sessions and are often at hyperkalemic levels by the next session. Conversely, potassium concentrations fall during each hemodialysis, and sometimes reach hypokalemic levels by the end. Low potassium dialysate, which rapidly decreases serum potassium and often brings it to hypokalemic levels, is almost universally considered a risk factor for life-threatening arrhythmias. While there is little doubt about the threat of lethal arrhythmias due to hyperkalemia, convincing evidence for the danger of low potassium dialysate and rapid or excess potassium removal has not been forthcoming. The original report of more frequent ventricular ectopy in early dialysis that was improved by reducing potassium removal has received very little confirmation from subsequent studies. Furthermore, the occurrence of ventricular ectopy during dialysis does not appear to predict mortality. Studies relating sudden deaths to low potassium dialysate are countered by studies with more thorough adjustment for markers of poor health. Dialysate potassium concentrations affect the excursions of serum potassium levels above or below the normal range, and have the potential to influence dialysis safety. Controlled studies of different dialysate potassium concentration and their effect on mortality and cardiac arrests have not been done. Until these results become available, I propose interim guidelines for the setting of dialysate potassium levels that may better balance risks and benefits.

show abstract

Section: Threat Of Rapid Fall In Plasma Potassium Levels During Dialysismentioning

confidence: 99%