P164 INCREASING DIALYSATE POTASSIUM CONCENTRATION EFFECTIVELY AND SAFELY REDUCES HYPOKALAEMIA IN HAEMODIALYSIS PATIENTS Willingham, F1,2, Stalker, M1, Fletcher, S1, Owen, S1, Kolhe, N2, Selby, N2,Fluck R2 1 Nutrition and Dietetic Department; 2Department of Renal Medicine, Royal Derby Hospital PROBLEM: Hypokalaemia is becoming increasingly prevalent in haemodialysis (HD) patients. There is increasing evidence to suggest that hypokalaemia itself, and the use of dialysate containing <2mmol potassium (K), both increase mortality. Audit of pre-dialysis potassium levels in our HD population revealed that K<4.0mmol/l was becoming increasingly common. This led to us consider the benefit of using a higher potassium dialysate as standard, and the subsequent change from a 1mmol potassium dialysate to a 2mmol potassium dialysate. METHOD: Pre-dialysis potassium levels in the HD population were audited to determine the numbers of patients with both hypo- and hyperkalaemia, and highlighted that K<4.0mmol/l was more prevalent than K>6.0mmol/l. The potassium concentration of standard dialysate was therefore changed from 1mmol to 2mmol. All patients with stable serum potassium <6mmol/l changed to 2mmol potassium dialysate, although patients with serum potassium levels >6mmol/l in 2 or more blood tests within the preceding 3 months remained on 1mmol potassium dialysate. The pre-dialysis serum potassium levels for 2 months before and after the change were analysed to assess its effectiveness. RESULTS: From a total hospital HD population of 210, 192 patients changed from 1mmol to 2mmol potassium dialysate. There was no significant difference in mean pre-dialysis K levels, and a significant reduction in those with hypokalaemia without increasing hyperkalaemia. Results are summarised in Table 1. Table 1. Changes in pre-dialysis potassium levels with changing to 1mmol K dialysate Pre-intervention Post-intervention p Mean pre-HD serum K (mmol/l) 4.3 +/- 0.7 4.7 +/- 0.7 p<0.0001 % of patients with pre-HD serum K 10% 4.4% p=0.02 <3.5mmol/l (%) % of patients with pre-HD serum K 27.8% 12.3% p<0.0001 <4.0mmol/l (%) % of patients with pre-HD serum K 1.0% 3.1% p=0.074 >6.0mmol/l (%) % of patients with pre-HD serum K 0% 0.3% NS >6.5mmol/l (%) 9 patients with pre-dialysis serum potassium levels which increased to >6mmol/l recommenced 1mmol potassium dialysate to prevent further hyperkalaemia CONCLUSION: This study has demonstrated the safety and effectiveness of changing to a higher potassium dialysate, by reducing the prevalence of hypokalaemia without increasing hyperkalaemia, and therefore reducing mortality risk in our hospital HD population.