Potassium metabolism in patients with chronic kidney disease. Part II: Patients on dialysis (stage 5)

Musso, Carlos G.

doi:10.1007/s11255-004-6194-y

Cited by 48 publications

(39 citation statements)

References 12 publications

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“…In this study, we observed changes in electrolytes and acid-base parameters similar to those changes described previously (24,26). However, we found no significant differences between patients with and without hemodialysis-induced LV systolic dysfunction.…”

Section: Discussionsupporting

confidence: 90%

Hemodialysis-Induced Regional Left Ventricular Systolic Dysfunction

Assa¹,

Hummel²,

Voors³

et al. 2012

Clinical Journal of the American Society of Nephrology

101

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Summary Background and objectives The hemodialysis procedure may acutely induce regional left ventricular systolic dysfunction. This study evaluated the prevalence, time course, and associated patient- and dialysis-related factors of this entity and its association with outcome. Design, setting, participants, & measurements Hemodialysis patients (105) on a three times per week dialysis schedule were studied between March of 2009 and March of 2010. Echocardiography was performed before dialysis, at 60 and 180 minutes intradialysis, and at 30 minutes postdialysis. Hemodialysis-induced regional left ventricular systolic dysfunction was defined as an increase in wall motion score in more than or equal to two segments. Results Hemodialysis-induced regional left ventricular systolic dysfunction occurred in 29 (27%) patients; 17 patients developed regional left ventricular systolic dysfunction 60 minutes after onset of dialysis. Patients with hemodialysis-induced left ventricular systolic dysfunction were more often male, had higher left ventricular mass index, and had worse predialysis left ventricular systolic function (left ventricular ejection fraction). The course of blood volume, BP, heart rate, electrolytes, and acid–base parameters during dialysis did not differ significantly between the two groups. Patients with hemodialysis-induced regional left ventricular systolic dysfunction had a significantly higher mortality after correction for age, sex, dialysis vintage, diabetes, cardiovascular history, ultrafiltration volume, left ventricular mass index, and predialysis wall motion score index. Conclusions Hemodialysis induces regional wall motion abnormalities in a significant proportion of patients, and these changes are independently associated with increased mortality. Hemodialysis-induced regional left ventricular systolic dysfunction occurs early during hemodialysis and is not related to changes in blood volume, electrolytes, and acid–base parameters.

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Section: Discussionsupporting

confidence: 90%

Hemodialysis-Induced Regional Left Ventricular Systolic Dysfunction

Assa¹,

Hummel²,

Voors³

et al. 2012

Clinical Journal of the American Society of Nephrology

101

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“…Therefore, although the degree of Kt/V did not influence serum potassium level during the study period in our study, inadequate haemodialysis in addition to poor dietary compliance could be still considered as the main cause of hyperkalaemia because the regulation of potassium homeostasis mainly depends on dialysis in ESRD patients on maintenance haemodialysis [17]. Besides high dietary potassium intake, there are other obvious factors to induce hyperkalaemia on stable patients on maintenance haemodialysis without ongoing hypercatabolic state, severe metabolic acidosis and reduction in the dialysis clearance are: (i) drugs used concomitantly that interfere potassium homeostasis, (ii) hypoaldosteronism and (iii) reduction in residual renal function [18]. But, in this study, those drugs such as b-blockers, diuretics, digoxin and NSAIDs did not affect serum potassium levels significantly during the 3-month study period.…”

Section: Discussionmentioning

confidence: 99%

No impact of hyperkalaemia with renin-angiotensin system blockades in maintenance haemodialysis patients

Han

Won

et al. 2007

Nephrology Dialysis Transplantation

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Background. Renin-angiotensin system (RAS) blockades, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are well accepted for the cardiorenal-protective benefits added to antihypertensive effects in chronic kidney diseases (CKD), but associated with an increased risk of hyperkalaemia. However, few studies have investigated the effect of RAS blockades on serum potassium in dialysis patients. Methods. Hyperkalaemia associated with RAS blockades by ACEI and/or ARB was evaluated in 69 patients on maintenance haemodialysis, who underwent a three-period crossover study in four groups (no exposure to RAS blockades, ACEI or ARB alone and ACEI plus ARB treatments), lasting one month in each period. Results. Sixty-two patients completed this prospective 3-month study, and no one stopped the study because of the development of hyperkalaemia and/or complications. Mean serum K was similar among the four periods (no exposure, 5.54 AE 0.67 mmol/l; ACEI alone, 5.54 AE 0.75 mmol/l; ARB alone, 5.50 AE 0.66 mmol/l; ACEI þ ARB combination, 5.42 AE 0.66 mmol/l) and was also equal when compared between the two groups with and without exposure to RAS blockades (5.48 AE 0.68 vs 5.54 AE 0.67 mmol/l, P ¼ NS). The incidence of severe hyperkalaemic episodes (>6.0 mmol/l) upon monthly predialysis serum K determination was 25.8% with no exposure to RAS blockades, 29.8% for ACEI alone, 19.6% for ARB alone and 17.7% for ACEI þ ARB combination without statistically significant differences among the four periods (P ¼ NS). Among covariables, the degree of Kt/V, intakes of other medications interfering with potassium homeostasis and diabetes mellitus did not result in any significant hyperkalaemic changes during the 3-month study period except anuric patients compared with non-anuric patients (5.58 AE 0.69 vs 5.19 AE 0.65 mmol/l, P < 0.001). Conclusion. Neither monotherapy (ACEI or ARB) nor combination therapy (ACEI plus ARB) is associated with the additional risk of hyperkalaemia in patients on maintenance haemodialysis. However, those patients with anuria on RAS blockades warrant the cautious monitoring of serum K to prevent hyperkalaemia.

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“…If A-RRT is delayed, the ESKD patient may experience ‘rebound hyperkalemia' as the potassium ions return into the extracellular space but are not excreted by the kidneys [61]. Conversely, hypokalemia during RRT should be avoided because of the risk of cardiac arrhythmia and careful monitoring of potassium levels should be advocated [63]. The loss of ability to excrete a free-water load predisposes to the development of moderate-to-severe hypotonic hyponatremia.…”

Section: Ckd/eskd Patients Admitted In the Icumentioning

confidence: 99%

Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

Rosa

Samoni²,

Villa³

et al. 2017

Blood Purif

3,608

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Patients with chronic kidney disease (CKD) are at high risk for developing critical illness and for admission to intensive care units (ICU). ‘Critically ill CKD patients' frequently develop an acute worsening of renal function (i.e. acute-on-chronic, AoC) that contributes to long-term kidney dysfunction, potentially leading to end-stage kidney disease (ESKD). An integrated multidisciplinary effort is thus necessary to adequately manage the multi-organ damage of those kidney patients and contemporaneously reduce the progression of kidney dysfunction when they are critically ill. The aim of this review is to describe (1) the pathophysiological mechanisms underlying the development of AoC kidney dysfunction and its role in the progression toward ESKD; (2) the most common clinical presentations of critical illness among CKD/ESKD patients; and (3) the continuum of care for CKD/ESKD patients from maintenance hemodialysis/peritoneal dialysis to acute renal replacement therapy performed in ICU and, vice-versa, for AoC patients who develop ESKD.

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Potassium metabolism in patients with chronic kidney disease. Part II: Patients on dialysis (stage 5)

Cited by 48 publications

References 12 publications

Hemodialysis-Induced Regional Left Ventricular Systolic Dysfunction

Hemodialysis-Induced Regional Left Ventricular Systolic Dysfunction

No impact of hyperkalaemia with renin-angiotensin system blockades in maintenance haemodialysis patients

Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

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