Low Potassium Dialysate Improves Hyperkalemia in ESRD patients

Pre-dialysis hyperkalemia is associated with higher mortality in ESRD patients on maintenance hemodialysis (HD) in the outpatient setting. The optimal treatment of hyperkalemia in hospitalized ESRD patients is nonexistent in literature which has prompted studies from outpatient dialysis to be extrapolated to inpatient care. Therefore, researchers of the University of Wisconsin School of Medicine and Public Health, USA, conducted a study to determine whether low potassium dialysate 1 meq/L is associated with higher mortality in hospitalized ESRD patients with severe hyperkalemia (serum potassium > 6.5 mmol/L).

It was a retrospective study of all adult ESRD patients admitted with severe hyperkalemia between January 2011- August 2016. The researchers included a total of 209 ESRD patients with severe hyperkalemia during the study period. The major outcome assessed was in-hospital death or cardiac arrest. Most patients received the 1 mEq/L potassium bath during the first hour of dialysis, then transitioned to higher potassium baths.

Key findings of the study were:

• Upon analysis, the researchers found that In-hospital mortality or cardiac arrest in ESRD patients with severe hyperkalemia was 12.4%.
• They noted that the median time to dialysis after serum potassium result was 2.0 hours (25, 75 IQR 0.9, 4.2 hours).
• They found that the use of 1mEq/L potassium bath was associated with significantly lower mortality or cardiac arrest in ESRD patients admitted with severe hyperkalemia (OR 0.27).

The authors concluded, "Use of 1K dialysis bath in hospitalized ESRD patients with severe hyperkalemia was associated with significantly lower risk of death or cardiac arrest compared to higher potassium dialysis bath."

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DOI: https://doi.org/10.1093/ckj/sfaa263