From the Guidelines
Potassium is added to the dialysis bath to prevent hypokalemia and maintain electrolyte homeostasis during hemodialysis treatment, with a recommended concentration that can be tailored to the individual patient's needs, as supported by the most recent guideline 1. The addition of potassium to the dialysis bath is crucial to prevent the development of hypokalemia, which can lead to cardiac arrhythmias, muscle weakness, and even cardiac arrest. According to the espen practical guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease 1, dialysis solutions containing potassium, phosphate, and magnesium should be used to prevent electrolyte disorders during KRT. The guideline suggests that the use of commercial KRT solutions enriched with phosphate, potassium, and magnesium can prevent the onset of hypophosphatemia, hypokalemia, and hypomagnesemia, and that the adoption of phosphate-containing KRT solutions has been reported as a safe and effective strategy to prevent CKRT-related hypophosphatemia. Key points to consider when determining the potassium concentration in the dialysis bath include:
- The patient's pre-dialysis serum potassium level
- The risk of hypokalemia and hyperkalemia
- The need to maintain electrolyte homeostasis during treatment
- The use of potassium-containing dialysate solutions to prevent hypokalemia, as recommended by the guideline 1. In terms of specific concentrations, the guideline does not provide a specific range, but it suggests that the potassium concentration should be tailored to the individual patient's needs, and that a concentration of 4 mEq/L can be used to minimize the onset of hypokalemia in course of CKRT 1. Overall, the addition of potassium to the dialysis bath is a critical component of hemodialysis treatment, and the concentration should be carefully calibrated to meet the individual patient's needs and prevent electrolyte disorders.
From the Research
Potassium in Dialysis Bath
- Potassium is added to the dialysis bath to maintain a neutral potassium balance in patients with kidney failure 2.
- The amount of potassium removed during hemodialysis is inversely proportional to the potassium concentration in the dialysis bath, and nephrologists adjust the dialysis bath potassium to account for individual variation in potassium intake among patients 2.
- Studies have shown that the use of a low-potassium dialysate can be beneficial for patients with hyperkalemia, as it can help to reduce the risk of cardiac arrest and mortality 3, 4.
Effects of Potassium Concentration in Dialysate
- Research has investigated the effects of different potassium concentrations in dialysate on total body potassium content in stable hemodialysis patients, with some studies finding no significant differences in total body potassium concentration between dialysates containing 0 or 2 mEq/L potassium 5.
- Other studies have examined the relationship between serum potassium levels and survival in hemodialysis patients, finding that a predialysis serum potassium level of 4.6 to 5.3 mEq/L is associated with the greatest survival 3.
Management of Hyperkalemia
- Hyperkalemia is a significant concern in hemodialysis patients, and the use of a low-potassium dialysate can be an effective strategy for managing this condition 4.
- However, the optimal approach to managing hyperkalemia in hemodialysis patients is not yet fully established, and further research is needed to determine the best course of treatment 6.