Prevalence and Management of Hypokalemia in Peritoneal Dialysis Patients in Qatar

Abstract

Introduction. Hypokalemia is common in patients undergoing peritoneal dialysis (PD). It is associated with increased cardiovascular and all-cause mortality. Treatment usually includes oral potassium supplements, which are poorly tolerated. Our aim was to evaluate the prevalence of hypokalemia in PD patients in Qatar and to improve treatment measures. Methods. All PD patients in Qatar with persistent hypokalemia and on potassium supplement were included. We performed a root cause analysis, and a management pathway was created. We collected data before (Period 1) and after (Period 2) implementation of the new pathway. Results. A total of 143 patients with a mean age of 54 years (range 21–82 years) were included in the study. Initial results of Period 1 showed hypokalemia in 48 patients (34%); of these, 14 (29%) had hypomagnesemia. Hypokalemia resolved in 10 of the patients after correction of their hypomagnesemia. The remaining 4 patients continued to require potassium supplementation despite correction of their hypomagnesemia. We started spironolactone (25 mg daily) in 13 of the hypokalemia patients. After 3 months, their mean serum potassium level improved from 3.2 ± 0.3 mmol/L to 3.9 ± 0.4 mmol/L (p<0.001), and the prevalence of patients with persistent hypokalemia decreased from 36% to 21% (statistically significant with p= 0.006). No episodes of hypotension or hyperkalemia were observed. Only 1 patient developed mild gynecomastia without discontinuation of the medications. Conclusion. Our study showed that hypokalemia is a prevalent problem in PD patients in Qatar. Hypomagnesemia is a significant contributing factor to hypokalemia in PD and correcting it leads to improvement of hypokalemia. Addition of spironolactone is safe and effective in treating hypokalemia. Implementing a holistic pathway led to a significant improvement in hypokalemia prevalence in PD patients.

Development of a preoperative index-based nomogram for the prediction of hypokalemia in patients with pituitary adenoma: a retrospective cohort study

“…Moreover, Marti et al showed that the prevalence of hypokalemia in patients presenting to the emergency department was 11%, which was considerably lower than our findings (38.05%). Hamad et al (2019) reported that the prevalence of hypokalemia in peritoneal dialysis patients was 34.0%, which was similar to our study. We suggest that the prevalence of hypokalemia in patients with PAs who undergo surgery is more common than that in general hospitalized patients; therefore, these cases should receive more attention from doctors.…”

Possibility of magnesium supplementation for supportive treatment in patients with COVID-19

“…In fact, low magnesium (hypomagnesemia) is often associated with hypocalcemia and hypokalemia ( Krämer and Endemann, 2000 ; William, 2018 ). In patients undergoing peritoneal dialysis, 29% of patients with hypokalemia are accompanied by hypomagnesemia ( Hamad et al, 2019 ). Thiazide diuretic therapy is the first-line treatment of hypertension, which often causes hypokalemia, and 40% of patients are accompanied by hypomagnesemia ( Krämer and Endemann, 2000 ).…”

Degree and duration of hypokalemia associated with peritonitis in patients undergoing peritoneal dialysis

“…Large international studies have reported that hypokalemia prevalence rates vary from 10% to 58% 2‐5 . In our centre, few patients (6.82%) had hypokalemia at baseline, and the SK levels decreased rapidly and then kept at a lower level for a very long period with the treatment of diet control and dialysis 8 .…”

“…Large international studies have reported that hypokalemia prevalence rates vary from 10% to 58%. [2][3][4][5] In our centre, few patients (6.82%) had hypokalemia at baseline, and the SK levels decreased rapidly and then kept at a lower level for a very long period with the treatment of diet control and dialysis. 8 Hypokalemia occurred in 53.7% of PD patients during the whole follow-up period, which reached the higher borderline level of the previous reports.…”

“…Hypokalemia (defined as serum potassium less than 3.5 mEq/L) is much more common in patients undergoing peritoneal dialysis (PD) than that of hemodialysis, [1][2][3][4] and the reported prevalence rates of hypokalemia vary from 10% to 58%. [2][3][4][5] Using potassium free dialysate, continuous clearing, decreased diet intake, and cellular uptake might be the reasons for hypokalemia.…”