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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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