Hypokalemia among patients undergoing peritoneal dialysis

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Watthikorn Pichitporn
Talerngsak Kanjanabuch

Abstract

At present, the number of patients with end stage kidney disease requiring kidney replacement therapy is increased dramatically. Peritoneal dialysis (PD), which is another choice of kidney replacement therapy, has also increased since the “Thailand PD first policy” pronouncement in 2008. Nevertheless, patients with PD sometimes face either infectious or noninfectious problems resulting in an increase in mortality and poor quality of life. Hypokalemia, defined as serum potassium below 3.5 mEq/L, is one of the most common causes of electrolyte abnormalities, accounting for 40-80% of patients with PD. In the past, this condition has not been of much concern, but current evidence has strongly shown that this condition produces various negative effects, such as increasing the risk of peritonitis, cardiovascular mortality and all-cause mortality. In addition, hypokalemia is also associated with protein energy wasting. Consequently, searching and correcting the causes are essential to prevent serious adverse events and may improve outcomes. According to multinational studies (PDOPPS), the main cause of hypokalemia among patients with PD is insufficient consumption of potassium from food. Only a small part of potassium is lost via urine and peritoneal dialysis and these values did not differ between normokalemic and hypokalemic patients with PD. This important condition should be prevented from occurring and would be better to treat immediately when detected. The appropriate serum potassium level is 4-5 mEq/L. Treatment by increasing high potassium diet, as well as taking potassium supplements, is the most effective strategy to maintain serum potassium to achieve the optimal level. However, no randomized controlled studies have proved the benefits of treating hypokalemia to improve outcomes, further study is needed.

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How to Cite
Pichitporn, W., & Kanjanabuch, T. (2022). Hypokalemia among patients undergoing peritoneal dialysis. Journal of the Nephrology Society of Thailand, 28(2), 30–40. Retrieved from https://he01.tci-thaijo.org/index.php/JNST/article/view/258798
Section
Review Article

References

Adisorn Lumpaopong TS, Kearkiat Praditpornsilpa et al. Annual Report Thailand Renal Replacement Therapy 2016-2019. TRT. 2020.

Brown EA, Blake PG, Boudville N, Davies S, de Arteaga J, Dong J, et al. International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis. Perit Dial Int. 2020;40(3):244-53.

Torlen K, Kalantar-Zadeh K, Molnar MZ, Vashistha T, Mehrotra R. Serum potassium and cause-specific mortality in a large peritoneal dialysis cohort. Clin J Am Soc Nephrol. 2012;7(8):1272-84.

Davies SJ, Zhao J, Morgenstern H, Zee J, Bieber B, Fuller DS, et al. Low Serum potassium Levels and Clinical Outcomes in Peritoneal Dialysis – International Results from PDOPPS. Kidney Int Rep. 2020.

van Ypersele de Strihou C. potassium homeostasis in renal failure. Kidney Int. 1977;11(6):491-504.

Tentori F ZJ BB, Kanjanabuch T, Kawanishi H, Perl J et al. International Variability in the prevalence of hypokalemia among patients on peritoneal dialysis: Results from PDOPPS. Nephrol Dial Transplant. 2017;32(296).

Zhang R, Wang Z, Fei Y, Zhou B, Zheng S, Wang L, et al. The Difference in Nutrient Intakes between Chinese and Mediterranean, Japanese and American Diets. Nutrients. 2015;7(6):4661-88.

Szeto CC, Chow KM, Kwan BC, Leung CB, Chung KY, Law MC, et al. Hypokalemia in Chinese peritoneal dialysis patients: Prevalence and prognostic implication. Am J Kidney Dis. 2005;46(1):128-35. Journal of the Nephrology Society of Thailand 39

Virojanawat M, Puapatanakul P, Chuengsaman P, Boonyakrai C, Buranaosot S, Katavetin P, et al. Hypokalemia in peritoneal dialysis patients in Thailand: The pivotal role of low potassium intake. Int Urol Nephrol. 2021.

Tchounwou P, Udensi U. potassium homeostasis, oxidative stress, and human disease. Int J Clin Exp Physiol. 2017;4(3).

Nakai K, Saito K, Fujii H, Nishi S. Impact of hypokalemia on peritonitis in peritoneal dialysis patients: A systematic review. Renal Replacement Therapy. 2017;3(1).

Chuang YW, Shu KH, Yu TM, Cheng CH, Chen CH. Hypokalaemia: An independent risk factor of Enterobacteriaceae peritonitis in CAPD patients. Nephrol Dial Transplant. 2009;24(5):1603-8.

Vavruk AM, Martins C, Nascimento MM, Hayashi SY, Riella MC. Association between hypokalemia, malnutrition and mortality in peritoneal dialysis patients. J Bras Nefrol. 2012;34(4):349-54.

Knochel JP. Neuromuscular manifestations of electrolyte disorders. Am J Med. 1982;72(3):521-35.

Lee S, Kang E, Yoo KD, Choi Y, Kim DK, Joo KW, et al. Lower serum potassium associated with increased mortality in dialysis patients: A nationwide prospective observational cohort study in Korea. PLoS One. 2017;12(3):e0171842. PMID: 5338775.

Asirvatham JR, Moses V, Bjornson L. Errors in potassium measurement: A laboratory perspective for the clinician. N Am J Med Sci. 2013;5(4):255-9.

LYE M. Whole body potassium and total exchangeable potassium in elderly patients with cardiac failure. BHJ. 1979;42:568-72.

Patrick J. Assessment of body potassium stores. Kidney Int. 1977;11(6):476-90.

Xu Q, Xu F, Fan L, Xiong L, Li H, Cao S, et al. Serum potassium levels and its variability in incident peritoneal dialysis patients: associations with mortality. PLoS One. 2014;9(1):e86750. PMID: 3903570.

Factor KF. potassium Management in Peritoneal Dialysis Patients. Int J Nutr Disord Ther. 2017;1(1): 003-5.

Phakdeekitcharoen B, Leelasa-nguan P. Effects of an ACE inhibitor or angiotensin receptor blocker on potassium in CAPD patients. Am J Kidney Dis. 2004;44(4):738-46.

Fang W, Oreopoulos DG, Bargman JM. Use of ACE inhibitors or angiotensin receptor blockers and survival in patients on peritoneal dialysis. Nephrol Dial Transplant. 2008;23(11):3704-10.

Fülöp T, Zsom L, Rodríguez B, Afshan S, Davidson JV, Szarvas T, et al. Clinical Utility of potassium-Sparing Diuretics to Maintain Normal Serum potassium in Peritoneal Dialysis Patients. Perit Dial Int. 2017;37(1): 63-9.

Langote A, Hiremath S, Ruzicka M, McCormick BB. Spironolactone is effective in treating hypokalemia among peritoneal dialysis patients. PLoS One. 2017;12(11):e0187269. PMID: 5681284.

Ito Y, Mizuno M, Suzuki Y, Tamai H, Hiramatsu T, Ohashi H, et al. Long-term effects of spironolactone in peritoneal dialysis patients. J Am Soc Nephrol. 2014;25(5):1094-102.

Yongsiri S, Thammakumpee J, Prongnamchai S, Tengpraettanakorn P, Chueansuwan R, Tangjaturonrasme S, et al. Randomized, double-blind, placebo-controlled trial of spironolactone for hypokalemia in continuous ambulatory peritoneal dialysis patients. Ther Apher Dial. 2015;19(1):81-6.

Shahram Taheri MM, Ali Pourmoghadas, Shiva Seyrafian, Zeynab Alipour, Shirin Karimi. A Prospective Double-Blind Randomized Placebo-Controlled Clinical Trial to Evaluate the Safety nd Efficacy of Spironolactone in Patients with Advanced Congestive Heart Failure on Continuous Ambulatory Peritoneal Dialysis. Saudi J Kidney Dis Transpl. 2012;23(3):507-12.

Amirmokri P, Morgan P, Bastani B. Intra-peritoneal administration of potassium and magnesium: A practical method to supplement these electrolytes in peritoneal dialysis patients. Ren Fail. 2007; 29(5):603-5.