Should You Give Lokelma to Your Dialysis Patient Today?
No, do not administer Lokelma on a dialysis day—the FDA label explicitly states that for patients on chronic hemodialysis, Lokelma should only be given on non-dialysis days. 1
Key Dosing Restriction for Dialysis Patients
- Lokelma is contraindicated on dialysis days because dialysis itself will effectively remove potassium, making the medication unnecessary and potentially increasing the risk of hypokalemia 1
- The FDA-approved dosing regimen specifies administration only on non-dialysis days, with a starting dose of 5 g once daily (or 10 g if serum potassium exceeds 6.5 mEq/L) 1
- Dosing adjustments should be based on pre-dialysis potassium values measured after the long interdialytic interval 1
Why This Restriction Exists
- Dialysis is the definitive emergency treatment for severe hyperkalemia and will rapidly correct potassium levels during today's session 2, 3
- Combining Lokelma with dialysis on the same day creates unnecessary risk of overcorrection and hypokalemia, particularly since Lokelma's effects persist beyond the dialysis session 1
- The medication works throughout the GI tract over hours to days, which overlaps inappropriately with the immediate potassium removal achieved by dialysis 4
What to Do Instead
For today: Allow dialysis to correct the hyperkalemia—this is the appropriate acute intervention 2, 3
For tomorrow (non-dialysis day): Consider initiating Lokelma at 5 g once daily if:
- Pre-dialysis potassium remains elevated after the long interdialytic interval 1
- The patient has recurrent hyperkalemia between dialysis sessions 1
- You want to maintain better potassium control and potentially reduce dietary restrictions 5
Important Monitoring Considerations
- Assess serum potassium one week after initiating Lokelma or adjusting the dose 1
- Monitor for dose-dependent edema (2% at 5 g daily, 6% at 10 g, 14% at 15 g) 2
- Watch for hypokalemia, especially if using higher doses—discontinue if potassium falls below target range 1
- Be aware that each 5 g dose contains 400 mg sodium, which may be relevant for fluid management in dialysis patients 2
Common Pitfall to Avoid
Never assume Lokelma can substitute for dialysis in severe hyperkalemia—it has a 1-2 hour onset and is not indicated for life-threatening hyperkalemia requiring immediate intervention 2, 3. The medication is designed for chronic management between dialysis sessions, not acute correction on dialysis days 1.