Hyperkalaemia prevalence, recurrence and management in chronic haemodialysis: a prospective multicentre French regional registry 2-year survey

Rossignol, Patrick; Lamiral, Zohra; Frimat, Luc; Girerd, Nicolas; Duarte, Kévin; Ferreira, João Pedro; Chanliau, Jacques; Castin, Nelly

doi:10.1093/ndt/gfx053

Cited by 32 publications

(42 citation statements)

References 14 publications

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“…The prevalence of HK, when defined as sK > 6 mmol/L, in HD ranges between 10 and 20% in the DOPPS (The Dialysis Outcomes and Practice Patterns Study) survey and DaVita data [ 28 , 29 ], while in PD it is about 7%, when defined as sK > 5.5 mmol/L [ 29 ]. However, a recent study has shown that the overall percentage of HD patients experiencing HK anytime over a 2-year follow-up period can be as high as 74% for sK > 5.1 mmol/L, 58% for sK > 5.5 mmol/L and 35% for sK > 6 mmol/L [ 9 ]. On the other hand, more than 25% PD patients have time-averaged sK < 4.0 mEq/L, a level that is associated with a significant increase in mortality risk in this population.…”

Section: Hyperkalemia In Dialysis Patientsmentioning

confidence: 99%

“…HD patients should restrict their daily dietary K to 2–3 g [ 36 ]. Because HK is currently and frequently recognized in the dialysis setting, it is quite clear that current strategies do not allow the full control of HK [ 9 ].…”

Section: Hyperkalemia In Dialysis Patientsmentioning

confidence: 99%

“…In fact, in patients with a GFR < 30 mL/min/1.73 m 2 , severe HK was detected in 1.8% of a large cohort in the US [ 7 ], and in approximately 4–5% in a recent Italian study [ 8 ]. However, the prevalence of sK > 6.0 mmol/L was reported as high as 34.5% in a recent epidemiological investigation [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…An additional but important grey area in the management of HK is the treatment of this electrolyte abnormality in dialysis patients. In this setting, sK levels are higher than in non-dialysis CKD, with about 60% and 35% of patients experiencing sK > 5.5 and > 6.0 mmol/L, respectively [ 9 ]. HK is more common during the long interdialytic interval and in patients treated with RAASIs to treat underlying cardiovascular disease as in those that need hypertonic dialysate because of poor intradialytic hemodynamic stability [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology

Bianchi

Aucella

Nicola³

et al. 2019

J Nephrol

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Hyperkalemia (HK) is the most common electrolyte disturbance observed in patients with kidney disease, particularly in those in whom diabetes and heart failure are present or are on treatment with renin-angiotensin-aldosterone system inhibitors (RAASIs). HK is recognised as a major risk of potentially life threatening cardiac arrhythmic complications. When an acute reduction of renal function manifests, both in patients with chronic kidney disease (CKD) and in those with previously normal renal function, HK is the main indication for the execution of urgent medical treatment and the recourse to extracorporeal replacement therapies. In patients with end-stage renal disease, the presence of HK not responsive to medical therapy is an indication at the beginning of chronic renal replacement therapy. HK can also be associated indirectly with the progression of CKD, because the finding of high potassium values leads to withdrawal of treatment with RAASIs, which constitute the first choice nephro-protective treatment. It is therefore essential to identify patients at risk of developing HK, and to implement therapeutic interventions aimed at preventing and treating this dangerous complication of kidney disease. Current strategies aimed at the prevention and treatment of HK are still unsatisfactory, as evidenced by the relatively high prevalence of HK also in patients under stable nephrology care, and even in the ideal setting of randomized clinical trials where optimal treatment and monitoring are mandatory. This position paper will review the main therapeutic interventions to be implemented for the prevention, detection and treatment of HK in patients with CKD on conservative care, in those on dialysis, in patients in whom renal disease is associated with diabetes, heart failure, resistant hypertension and who are on treatment with RAASIs, and finally in those presenting with severe acute HK.

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Section: Hyperkalemia In Dialysis Patientsmentioning

confidence: 99%

Section: Hyperkalemia In Dialysis Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology

Bianchi

Aucella

Nicola³

et al. 2019

J Nephrol

View full text Add to dashboard Cite

show abstract

“…Furthermore, this K þ -binding agent has been associated with gastrointestinal intolerance and serious gastrointestinal complications. [71][72][73] The US Food and Drug Administration warns against using SPS with sorbitol because of cases of intestinal necrosis and other serious gastrointestinal events (e.g., bleeding, ischemic colitis, and perforation). 74 They also recommend separating the administration of SPS from other oral medicines by $3 hours because of the nonspecific binding properties of SPS.…”

Section: Nondialysis Options For Managing Hyperkalemiamentioning

confidence: 99%

Current Management of Hyperkalemia in Patients on Dialysis

Bansal

Pèrgola

2020

Kidney International Reports

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Patients with end-stage renal disease (ESRD) on maintenance dialysis have a high risk of developing hyperkalemia, generally defined as serum potassium (K þ) concentrations of >5.0 mmol/l, particularly those undergoing maintenance hemodialysis. Currently, the key approaches to the management of hyperkalemia in patients with ESRD are dialysis, dietary K þ restriction, and avoidance of medications that increase hyperkalemia risk. In this review, we highlight the issues and challenges associated with effective management of hyperkalemia in patients undergoing maintenance dialysis using an illustrative case presentation. In addition, we examine the potential nondialysis options for the management of these patients, including use of the newer K þ binder agents patiromer and sodium zirconium cyclosilicate, which may reduce the need for the highly restrictive dialysis diet, with its own implication on nutritional status in patients with ESRD, as well as reducing the risk of potentially life-threatening hyperkalemia.

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Hyperkalaemia and hypokalaemia outpatient management: a survey of 500 French general practitioners

et al. 2020

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Aims How general practitioners (GPs) manage dyskalaemia is currently unknown. This study aimed at describing GP practices regarding hypokalaemia or hyperkalaemia diagnosis and management in their outpatients. Methods and results A telephone survey was conducted among French GPs with a 20-item questionnaire (16 closed-ended questions and 12 open-ended questions) regarding their usual management of hypokalaemia or hyperkalaemia patients, both broadly and more specifically in patients with heart failure and/or chronic kidney disease and/or in patients treated with angiotensin-converting enzyme/angiotensin receptor blockers or mineralocorticoid receptor antagonists. We aimed to interview 500 GPs spread geographically throughout France. This descriptive survey results are presented as mean ± standard deviation (if normally distributed or as median and inter-quartile range if the distribution was skewed). Categorical variables are expressed as frequencies and proportions (%). A total of 500 GPs participated in the study. Dyskalaemia thresholds (for diagnosis and intervention) and management patterns were highly heterogeneous. The mean ± SD (range) potassium level leading to 'intervene' was 5.32 ± 0.34 mmol/L (4.5-6.5) for hyperkalaemia and 3.23 ± 0.34 mmol/L (2.0-6.5) for hypokalaemia. Potassium levels leading to refer the patient to the emergency department (ED) were 6.14 ± 0.55 (4.5-10) and 2.69 ± 0.42 mmol/L (1-4), respectively. Potassium binders (51-65%) or potassium supplements (67-74%) were frequently used to manage hyperkalaemia or hypokalaemia. GPs uncommonly referred their dyskalaemic patients to cardiologists or nephrologists (or to the emergency department, if the latter was deemed necessary owing to the severity of the dyskalaemia). We identified an association between the close vicinity of GP office from an ED and 'referring a heart failure patient' (19.2% with ED vs. 8.6% without ED) and referring a heart failure and chronic kidney disease patient on mineralocorticoid receptor antagonist (16.7% with ED vs. 9.3% without ED). Although the majority (67%) of GPs had an electrocardiogram on hand, it was rarely used (14%) in dyskalaemic patients. Subgroup analyses considering gender, age of the participating GPs, and high-income/lowincome regions did not identify specific patterns regarding the multidimensional aspect of dyskalaemia management. Conclusions Owing to the considerable heterogeneity of French GP practices toward dyskalaemia diagnosis and management approaches, there is a likely need to standardize (potentially enabled by therapeutic algorithms) practices.

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Hyperkalaemia prevalence, recurrence and management in chronic haemodialysis: a prospective multicentre French regional registry 2-year survey

Abstract: HK was found to be highly prevalent and recurrent in this regional registry despite the widespread and dynamic prescription of low-K dialysis baths and K binders. More effective potassium mitigating strategies are eagerly warranted.

Cited by 32 publications

References 14 publications

Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology

Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology

Current Management of Hyperkalemia in Patients on Dialysis

Hyperkalaemia and hypokalaemia outpatient management: a survey of 500 French general practitioners

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