Iris Publishers- Open access Journal of  Urology & Nephrology | Hemodialysis (HD) Dialysate Potassium 

Authored by David Tovbin

Extremes of serum potassium levels in the general population, cardiac patients and hemodialysis (HD) patients may be critical. Thus, dialysate potassium concentration needs to be individualized to the patients by a standardized approach of the nephrologists. Our goals are to avoid or minimize pre-HD hyperkalemia, post-HD hypokalemia and high intradialytic dialysate-plasma K gradient, in order to moderate the high mortality and morbidity in HD patients and improve their compromised quality of life (QOL). However, dialysate K is frequently not individualized 400 events of cardiac arrests were reported during 5,745,000 (7/100,000) HD sessions over 9 months [1]. Cardiac arrest was more frequent on the day after the weekend HD sessions than any other days. Cardiac arrest was twice frequent (17 vs 8.8%) when dialysate K was 0-1 mEq/L. In only 18% of those sessions with dialysate K of 0-1 mEq/L, pre-HD K was >5 mEq/L. Among many patients on dialysate K of 0-2 mEq/L pre-HD K<4 mEq/L was recorded. These data may suggest that not Individualizing dialysate K and using low dialysate K in hypokalemic patients is not infrequent and is associated with cardiac arrest. Cardiac arrest may be the tip of the iceberg, and extremes of serum K levels in HD patients may be associated with weakness, exhaustion, cramps, falls fractures, hemorrhage, accidents and reduced QOL.HD dialysate K is recommended to be individualized in textbooks such as Daugirdas-Handbook of dialysis; standard dialysate potassium is 2 mEq/L but If pre-HD K<4.5 mEq/L or patient is treated with digitalis; dialysate K of 3mEq/L is recommended. Moreover, if those patients are hyperkalemic on dialysate K of 3 mEq/L, administration of Kay Exelate is recommended. It is also recommended to increase dialysate K to avoid hypokalemia in malnourished patients who may have low pre-HD serum K, to avoid dialysate K of 1 mEq/L in hyperkalemia due to its` association with cardiac arrest, and to use low K dialysate only for a short term in case of stopping high K diet. However, in other studies results and recommendations were not in line with those recommendations. In 57000 HD patients, pre-HD serum K of 4.6-5.3mEq/L was associated with the greatest survival, but patients with pre-HD serum K >5 mEq/L had better survival on lower dialysate K [2].

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