Effect of fludrocortisone acetate on reducing serum potassium levels in patients with end-stage renal disease undergoing haemodialysis

Abstract

Background. Hyperkalaemia is a commonly encountered problem in dialysis patients with end-stage renal disease (ESRD). The aim of the present study was to assess the effect of fludrocortisone acetate (FCA) on reducing serum potassium levels in haemodialysis (HD) patients with hyperkalaemia. Methods. Prospectively, 21 HD patients with hyperkalaemia were enrolled in this study. Patients were divided into two groups, including FCA (0.1 mg/d, n ¼ 13) administration or no treatment (control, n ¼ 8) for 10 months. No changes in dialysis or drug regimens were made during this period.Result. There were no significant differences in the baseline characteristics and biochemical parameters between the two groups (FCA therapy and control). At 10-months after FCA therapy, serum potassium levels were not significantly different between the treatment and control groups [median value (range): 5.2 (4.4-6.0) vs 5.8 (4.8-6.3) mEq/l, P ¼ 0.121]. However, using the Wilcoxon signed ranks test, serum potassium levels were significantly lower at the end of the 10 month time period after FCA therapy compared with serum potassium levels of the pre-treatment period [5.2 (4.4-6.0) vs 6.1 (5.3-6.8), P ¼ 0.01]. The biochemical values, including sodium, chloride, protein, albumin, blood nitrogen, creatinine, interdialytic weight change and blood pressure, did not show significant difference in comparisons between the two groups and pre-and post-FCA therapy period. Conclusions. FCA therapy appears to slightly decrease serum potassium value in hyperkalaemic HD patients. However, these results are insufficient to explain the effectiveness of FCA. Therefore, potentially large-scale studies with increased dose concentrations are needed to minimize the positive potassium balance in hyperkalaemic HD patients.

Management of patients with acute hyperkalemia

“…We excluded three of these studies because treatment allocation had not been randomized. [18][19][20] One study, published in 2003, was included in the prior review. 21 Therefore, we included in this updated review 5 new studies, [22][23][24][25][26] along with the 11 studies 21,[27][28][29][30][31][32][33][34][35][36] reviewed by Mahoney and associates 14 (Appendix 1, available at www .cmaj .ca /cgi /content /full /cmaj .100461 /DC1).…”

Refractory hyperkalemia related to heparin abuse

“…[12] Fludrocortisone has been shown to decrease serum potassium levels in end stage renal disease other than routine therapy. [1314] Fludrocortisone stimulates the Na + -K + ATPase activity and increase potassium secretion from gastrointestinal tract. [13] Another mechanism suggested has been the intracellular shift of potassium.…”

“…[1314] Fludrocortisone stimulates the Na + -K + ATPase activity and increase potassium secretion from gastrointestinal tract. [13] Another mechanism suggested has been the intracellular shift of potassium. [13] Several studies have shown potassium lowering effect of fludrocortisone in the dose range of 0.1-0.3 mg/day.…”

“…[13] Another mechanism suggested has been the intracellular shift of potassium. [13] Several studies have shown potassium lowering effect of fludrocortisone in the dose range of 0.1-0.3 mg/day. [1415] We also started our patient on fludrocortisone 0.1 mg OD, but could not find any benefit.…”

Sailing Between Scylla and Charybdis: The High Serum K–Low Dialysate K Quandary

“…The reduction in K was seen with nondiarrhea‐inducing doses and was attributed to a cAMP‐mediated effect on colonic K secretion.Despite promising results in small studies [(summarized in ], only a small (mean 4.8 vs. 5.2 mEq/l) insignificant difference in pre‐HD serum K levels was found in HD patients randomized to fludrocortisone 0.1 mg daily ( n = 18) versus placebo ( n = 19) . More recently, 13 patients treated by fludrocortisone (0.1 mg daily) had lower serum K levels at the end of the 10‐month observation period compared with baseline, but without difference from the 8 controls . Larger long‐term studies, including those assessing higher doses, are needed to determine the place, if any, of fludrocortisone.…”