Incidence and Factors Associated Among Continuous Ambulatory Peritoneal Patients Undergoing Dialysis with Hypokalemia in Hua-Hin Hospital

Abstract

Background: Hypokalemia is a common electrolyte disturbance among patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and is associated with adverse clinical outcomes including malnutrition, catheter malfunction, peritonitis, and increased hospitalization. However, data on its incidence and contributing factors among Thai CAPD patients remain limited.

Objective: To determine the incidence of hypokalemia and identify associated clinical and dialysis-related factors among CAPD patients at Hua-Hin Hospital, Prachuap Khiri Khan Province, Thailand.

Methods: This retrospective analytic study reviewed medical records of 124 end-stage renal disease (ESRD) patients who received CAPD at Hua-Hin Hospital between January 2019 and December 2024. Demographic data, comorbidities, dialysis prescriptions, laboratory parameters, medications, and clinical complications were analyzed. Hypokalemia was defined as serum potassium < 3.5 mEq/L. Statistical analyses included chi-square test, t-test, and multiple logistic regression.

Results: The incidence of hypokalemia among CAPD patients was 36.3%. Most cases (84.4%) presented with mild to moderate hypokalemia (serum potassium 2.5-3.5 mEq/L), while 15.6% had severe hypokalemia (< 2.5mEq/L). Factors significantly associated with hypokalemia included presence of diabetes mellitus (P = 0.004), lower serum albumin (P = 0.001), reduced serum magnesium (p = 0.030), and decreased serum bicarbonate (P = 0.010). Higher peritoneal ultrafiltration volume and certain dialysis prescriptions were also correlated. However, use of diuretics, RAAS inhibitors, insulin, or alkali therapy showed no significant associations. Hypokalemia was significantly associated with increased rates of malnutrition (p < 0.001), catheter malfunction (p = 0.007), peritonitis (p = 0.012), and hospitalization (p = 0.005). Mortality was higher in the hypokalemia group (22.2% vs. 11.4%) though not statistically significant.

Conclusion: Hypokalemia is prevalent among CAPD patients and is associated with both clinical and dialysis-related complications. Nutritional status, electrolyte balance, and dialysis prescription should be closely monitored. Preventive strategies including early potassium supplementation and individualized dialysis planning may reduce complications and improve patient outcomes.