From the Guidelines
Dialysis is a highly effective treatment for lowering potassium levels in patients with hyperkalemia, particularly in severe or refractory cases. According to the most recent and highest quality study published in the Mayo Clinic Proceedings in 2021 1, hemodialysis increases total potassium elimination and may be used for resistant acute hyperkalemia. The process of dialysis works by creating a concentration gradient that allows potassium to move from the blood into the dialysate solution, thereby reducing serum potassium levels.
Key factors that influence the effectiveness of potassium removal during dialysis include:
- Blood flow rate
- Dialysate potassium concentration, typically set at 0-2 mEq/L for hyperkalemic patients
- Duration of treatment
- The patient's total body potassium
While dialysis provides definitive treatment, temporary measures such as insulin with glucose, nebulized albuterol, or calcium gluconate may be used to stabilize cardiac membranes while preparing for dialysis, as noted in another study published in the same journal in 2021 1. For patients with chronic kidney disease not yet on dialysis, initiating dialysis may be necessary if hyperkalemia is severe and unresponsive to medical management.
In terms of the magnitude of potassium reduction, hemodialysis can typically lower potassium levels by 1-2 mEq/L within the first hour of treatment, making it one of the most rapid and effective methods for reducing serum potassium in severe or refractory hyperkalemia. Overall, dialysis is a critical treatment option for managing hyperkalemia, particularly in patients with end-stage renal disease or severe hyperkalemia that is unresponsive to medical management.
From the Research
Effect of Dialysis on Potassium Levels
- Dialysis is a treatment option for hyperkalemia in patients with renal failure, as it can help remove excess potassium from the body 2.
- The use of low-potassium dialysate (1 mEq/L) has been associated with lower mortality in end-stage renal disease patients admitted to hospital with severe hyperkalemia 3.
- Dialysis can remove potassium from the body through diffusion, with hemodialysis removing an average of 70-150 mmol per session and peritoneal dialysis removing approximately 30-40 mmol per day 4.
Mechanisms of Potassium Removal
- Potassium is removed mainly by diffusion during dialysis, and the presence of glucose-free dialysate, sodium profiling, and hyperkalemia may increase its removal 4.
- Hemofiltration removes approximately 60 mmol of potassium per treatment, while peritoneal dialysis patients may experience hypokalemia due to movement of potassium into the cells mediated by insulin 4.
Management of Hyperkalemia
- Dialysis is the definitive treatment of hyperkalemia in patients with end-stage renal disease, and may be used in conjunction with other treatments such as intravenous calcium, insulin, and nebulized albuterol 5.
- Prevention of hyperkalemia currently rests largely upon dietary compliance and avoidance of medications that may promote hyperkalemia, as well as administration of intravenous dextrose to prevent hyperkalemia during prolonged fasting 5.
- Calcium-polystyrene sulfonate (Ca-PS) has been shown to decrease inter-dialytic hyperkalemia in patients undergoing maintenance hemodialysis, by reducing serum potassium levels and peaked T-wave occurrence 6.