Dialysate potassium concentration: Should mass balance trump electrophysiology?. Issue 6 (19th July 2018)

• Record Type: Journal Article
• Authors: Pun, Patrick H.
• Other Names: Kovesdy Csaba P. guestEditor.; Sumida Keiichi guestEditor.
• Is Part Of: Seminars in dialysis. Volume 31:Issue 6(2018)
• Page Start: 569
• Page End: 575
• Publication Date: 2018-07-19
• Subjects: chronic hemodialysis -- clinical epidemiology -- electrolytes -- end‐stage kidney disease; Hemodialysis -- Periodicals; Dialysis -- Periodicals; Renal Dialysis -- Periodicals; 617.461059
• DOI: 10.1111/sdi.12738
• Languages: English
• ISSNs: 0894-0959

Abstract

Abstract: Nephrologists are faced with a difficult dilemma in choosing the ideal dialysis prescription to maintain neutral potassium mass balance. Should potassium mass balance goals prioritize the normalization of serum potassium levels using low potassium dialysate at the expense of provoking intradialytic arrhythmias, or should mass balance goals favor permissive hyperkalemia using higher dialysate potassium to avoid rapid intradialytic fluxes at the risk of more interdialytic arrhythmias? This review examines the factors that determine potassium mass balance among HD patients, the relationships between serum and dialysate potassium levels and outcomes, and concludes by examining currently available approaches to reducing risk of arrhythmias while managing potassium mass balance.