When a dialysis session becomes unstable, the
result can sometimes be sudden cardiac death, which is a leading cause of death
in patients on maintenance hemodialysis. During hemodialysis sessions, rapid
electrolytes shifts can occur, which may contribute to arrhythmias and sudden
death. While high pre-dialysis serum potassium is recognized as a risk factor
for sudden death and all-cause mortality in hemodialysis patients, the results
of studies examining the effects of dialysate potassium have been mixed.
Using data from 55,183 patients from 20
countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS),
researchers reexamined the risks of different dialysate potassium prescriptions
and explored the associations between pre-dialysis serum potassium levels and
outcomes as well as the association between dialysate potassium and serum
Consistent with prior studies, they found that
high serum potassium was associated with increased all-cause mortality and
arrhythmia/sudden death. However, they found minimal difference in the risk of
adverse events between a dialysate potassium prescription of 3 vs. 2 mEq/L, at
any given serum potassium level. They also found only minimal impact of
dialysate potassium on pre-dialysis serum potassium.
“We cannot provide a recommendation for any
immediate changes in practice based on our null findings, though in the long
term, our results support equipoise for future research of an easily modifiable
practice pattern in a randomized setting,” said lead author Angelo
The authors conclude that approaches other than
altering dialysate potassium concentration (e.g., education to reduce dietary
potassium intake, prescription of potassium-binding medications) may merit
further attention to reduce risks such as sudden death.
Karaboyas A, Zee J, Brunelli SM, Usvyat LA, Weiner DE, Maddux FW, Nissenson AR, Jadoul M, Locatelli F, Winkelmayer WC, Port FK, Robinson BM, Tentori F. Dialysate Potassium, Serum Potassium, Mortality and Arrhythmia Events in Hemodialysis: Results from the DOPPS. Am J Kidney Dis. 2017;69(2):266-277.
View PubMed entry
Read the full article in AJKD
Download slide presentation
View more Arbor Research publications
November 21, 2016