American Journal of Kidney Diseases

Dialysate and Serum Potassium in Hemodialysis

Published:March 28, 2015DOI:
      Most patients with end-stage renal disease depend on intermittent hemodialysis to maintain levels of serum potassium and other electrolytes within a normal range. However, one of the challenges has been the safety of using a low-potassium dialysate to achieve that goal, given the concern about the effects that rapid and/or large changes in serum potassium concentrations may have on cardiac electrophysiology and arrhythmia. Additionally, in this patient population, there is a high prevalence of structural cardiac changes and ischemic heart disease, making them even more susceptible to acute arrhythmogenic triggers. This concern is highlighted by the knowledge that about two-thirds of all cardiac deaths in dialysis are due to sudden cardiac death and that sudden cardiac death accounts for 25% of the overall death for end-stage renal disease. Developing new approaches and practice standards for potassium removal during dialysis, as well as understanding other modifiable triggers of sudden cardiac death, such as other electrolyte components of the dialysate (magnesium and calcium), rapid ultrafiltration rates, and safety of a number of medications (ie, drugs that prolong the QT interval or use of digoxin), are critical in order to decrease the unacceptably high cardiac mortality experienced by hemodialysis-dependent patients.

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      Linked Article

      • Erratum Regarding “Dialysate and Serum Potassium in Hemodialysis” (Am J Kidney Dis. 2015;66[1]:125-132)
        American Journal of Kidney DiseasesVol. 66Issue 5
        • Preview
          In the In Practice article entitled “Dialysate and Serum Potassium in Hemodialysis” that appeared in the July 2015 issue of AJKD (Hung & Hakim, volume 66, issue 1, pages 125-132), there were errors in the description, dose information, and reported results for 2 new oral agents for the treatment of hyperkalemia.
        • Full-Text
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      • Dialysate and Serum Potassium in Hemodialysis
        American Journal of Kidney DiseasesVol. 67Issue 1
        • Preview
          Hung and Hakim1 described factors associated with sudden cardiac death in patients on hemodialysis therapy, using a sample case in which a patient had cardiac arrest in the second half of dialysis and basing the subsequent discussion on possible factors that could have contributed to this outcome. Given the article topic, the authors focus on potassium balance and note that normal or slightly elevated predialysis serum potassium levels and using a lower dialysate potassium concentration in patients with hyperkalemia have been associated with the greater likelihood of survival.
        • Full-Text
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