Prevalence and pathogenesis of hypokalemia in patients on chronic peritoneal dialysis: One center's experience and review of the literature

Tziviskou, Effie; Musso, Carlos G.; Bellizzi, Vincenzo; Khandelwal, Mukesh; Wang, Tao; Savaj, Shokoufeh; Oreopoulos, Dimitrios G.

doi:10.1023/b:urol.0000022867.93739.03

Cited by 45 publications

(37 citation statements)

References 11 publications

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“…Thus, whereas 26% of patients had time-averaged serum potassium ,4.0 mEq/L, 18% had levels $5.0 mEq/L. However, the prevalence of serum potassium ,3.5 mEq/L (4% timeaveraged values) in our cohort is lower than previously reported (7%-36%) from single-center studies (10,(14)(15)(16). Our estimates likely have greater external validity because they were derived from a large multicenter cohort of PD patients.…”

Section: Discussioncontrasting

confidence: 55%

“…Nevertheless, other reasons for the varying estimates of prevalence may include differences in dietary intakes of potassium and PD prescription (volume and tonicity of dialysate). Furthermore, cohorts may differ in the use of oral potassium supplements; previous studies suggest that 10%-29% of PD patients require potassium supplements (15,17,18). The high prevalence of hypokalemia in ESRD patients treated with PD is likely directly attributable, at least in part, to the dialysis modality.…”

Section: Discussionmentioning

confidence: 99%

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Serum Potassium and Cause-Specific Mortality in a Large Peritoneal Dialysis Cohort

Torlén

Kalantar-Zadeh

Molnar

et al. 2012

Clinical Journal of the American Society of Nephrology

126

134

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SummaryBackground and objectives Unlike hemodialysis (HD), peritoneal dialysis (PD) is a continuous therapy and does not induce myocardial stunning. Yet, the death risk in HD and PD patients is similar. This study tested the hypothesis that serum potassium abnormalities contribute more to the death risk in PD patients than in HD patients.Design, setting, participants, & measurements Data from patients treated in DaVita facilities between July 1, 2001 and June 30, 2006 (n=10,468 PD patients; n=111,651 HD patients) were used to determine association of serum potassium with mortality.Results PD patients were significantly more likely to have serum potassium ,4 mEq/L, with an adjusted odds ratio of 3.30 (95% confidence interval [95% CI], 3.05, 3.56). There was a U-shaped relationship between timeaveraged serum potassium and all-cause and cardiovascular mortality of PD patients, with adjusted hazards ratios of 1.51 for all-cause mortality for potassium ,3.5 mEq/L (95% CI, 1.29, 1.76) and 1.52 for potassium $5.5 mEq/L (95% CI, 1.32, 1.75). The population-attributable risks for all-cause mortality for serum potassium ,4.0 and $5.5 mEq/L were 3.6% and 1.9%, respectively, in PD patients, and 0.8% and 1.5%, respectively, in HD patients.Conclusions Abnormalities in serum potassium contribute disproportionately to the high death risk in PD patients. This may, in part, account for the equivalent cardiac risk seen with the two therapies.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Serum Potassium and Cause-Specific Mortality in a Large Peritoneal Dialysis Cohort

Torlén

Kalantar-Zadeh

Molnar

et al. 2012

Clinical Journal of the American Society of Nephrology

126

134

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“…This poor nutritional status can lead to de novo hypokalemia. In PD patients, insulin hormone, stimulated by the continuous glucose peritoneal dwell, can generate an increase of potassium redistribution into the intracellular compartment (Tziviskou et al, 2003). In the present study, the presence of diabetes and daily glucose load did not differ between the two groups, suggesting that intracellular potassium redistribution may not be the main mechanism of hypokalemia in our PD patients.…”

Section: De Novo Hypokalemia In Incident Pd Patientsmentioning

confidence: 47%

“…Serum potassium levels in PD patients are associated with nutritional status and severity of coexisting comorbid conditions. Hypokalemia in PD patients is due to a shift of potassium into the intracellular space, probably due to insulin release during the continuous dwell of the dialysis solution containing glucose (Tziviskou et al, 2003). Thus, cellular uptake may play an important role in the pathogenesis of hypokalemia.…”

Section: Pathophysiology Of Hypokalemia In Pd Patientsmentioning

confidence: 99%

Hyponatremia and Hypokalemia in Peritoneal Dialysis Patients

Kim¹

2011

Progress in Peritoneal Dialysis

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“…IP administration of K may be required and even lifesaving in patients undergoing PD who do not tolerate oral K supplements. [2] Hypokalemia may be severe enough to warrant emergency room visit and hospital admission. Pai et al reported a symptomatic hypokalemia incidence of 5% in the PD patients who presented to their emergency department.…”

Section: Introductionmentioning

confidence: 99%

Intra-Peritoneal Administration of Potassium and Magnesium: A Practical Method to Supplement These Electrolytes in Peritoneal Dialysis Patients

2007

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Background. Malnutrition and gastrointestinal (GI) losses are frequently encountered in peritoneal dialysis patients, leading to hypokalemia and hypomagnesemia. Oral supplementation is limited by patients' compliance, as well as GI side effects. Methods. Among the 27 patients on continuous cyclic peritoneal dialysis (CCPD) in whom we had one-year data, 15 (55%) were on oral potassium (K) supplements and 10 (37%) were on oral magnesium (Mg) supplements. Hypokalemia and hypomagnesemia persisted in 3 (11%) patients despite oral supplementation. We examined the efficacy and tolerability of intra-peritoneal (IP) K and Mg administration. Four grams of magnesium sulfate (MgSO4) and/or 60-80 mEq of potassium chloride (KCl) were added to a 2 liter, 2.5% peritoneal dialysis solution bag, and it was used as the last dwell in five CCPD patients. We serially measured serum K and Mg concentrations at 2, 4, and 6-8 hour intervals, drained the fluid, and measured serum concentrations at 20-24 hours. Results. Mean serum K concentration increased from a baseline of 3.2 mEq/L to 4.1, 4.2, 4.1, and 4.2 mEq/L at 2, 4, 6-8, and 20-24 hours post IP administration of KCl, respectively. Similarly, mean serum Mg concentration increased from a baseline of 1.5 mg/dL to 2.5, 2.9, 2.6, and 2 mg/dL at 2, 4, 6-8, and 20-24 hours post-IP administration of MgSO4, respectively. Patients tolerated IP replacement very well, and there were no adverse events. Serum K and Mg concentrations normalized in all patients. Conclusion. IP administration is a safe, practical, and effective method to supplement K and Mg in peritoneal dialysis patients.

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Prevalence and pathogenesis of hypokalemia in patients on chronic peritoneal dialysis: One center's experience and review of the literature

Cited by 45 publications

References 11 publications

Serum Potassium and Cause-Specific Mortality in a Large Peritoneal Dialysis Cohort

Serum Potassium and Cause-Specific Mortality in a Large Peritoneal Dialysis Cohort

Hyponatremia and Hypokalemia in Peritoneal Dialysis Patients

Intra-Peritoneal Administration of Potassium and Magnesium: A Practical Method to Supplement These Electrolytes in Peritoneal Dialysis Patients

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