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.