Potassium Balance in Dialysis Patients

  title={Potassium Balance in Dialysis Patients},
  author={Sarah F. Sanghavi and Susan Joyce Whiting and Jaime Uribarri},
  journal={Seminars in Dialysis},
The advent of dialytic therapy has enabled nephrologists to provide life‐saving therapy, but potassium balance continues to be an ever present challenge in the ESRD population. Although a small percent of patients are chronically hypokalemic, hyperkalemia is by far the most common abnormality in dialysis patients. It is associated with increased all‐cause mortality, cardiovascular mortality, and arrhythmogenic death. Although alterations of the dialysis bath may decrease predialysis potassium… 
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Patiromer sorbitex calcium and sodium zirconium cyclosilicate (ZS-9) are two new potassium-lowering compounds currently in development that have demonstrated efficacy and safety in recent trials.
Epidemiology, diagnosis and management of hypertension among patients on chronic dialysis
Estimates of the epidemiology of hypertension in the dialysis population as well as the challenges in diagnosing and managing hypertension among these patients are discussed.
Serum Potassium and Short-term Clinical Outcomes Among Hemodialysis Patients: Impact of the Long Interdialytic Interval.
Higher serum potassium is associated with increased short-term risk of hospitalization, ED visit, and death and is modified by day of the week, consistent with a contribution of accumulated potassium to adverse outcomes following the long interdialytic interval.
Hyperkalemia in Hemodialysis Patients
Reducing potassium intake through dietetic/nutritional support is critical to reducing the K+ load in ESRD patients and preventing this condition.
Nutrition Management in Hemodialysis
The range of factors that affect nutritional status in end-stage kidney disease is addressed, including the prevalence, methods of assessment, and management of the following issues: PEW, electrolyte disturbance, fluid balance, and vitamin and mineral deficiencies.
Modified Nutritional Recommendations to Improve Dietary Patterns and Outcomes in Hemodialysis Patients.
It is possible that the traditional renal diet may be liberalized, with a focus on whole foods low in sodium and phosphorus additives, to afford patients greater choices and ultimately improved outcomes.


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The majority of end‐stage renal disease (ESRD) patients are hypertensive and need a combination of several antihypertensive drugs for adequate BP control, and thrice‐weekly supervised administration of these drugs after HD can enhance BP control.
Serum potassium and cause-specific mortality in a large peritoneal dialysis cohort.
Abnormalities in serum potassium contribute disproportionately to the high death risk in PD patients, which may, in part, account for the equivalent cardiac risk seen with the two therapies.
Drug therapy for hypertension in hemodialysis patients.
Hypertension in chronic hemodialysis patients is very common, and associated with cardiovascular morbidity and mortality. On the other hand, normalization of blood pressure in this patient population
Modifiable risk factors associated with sudden cardiac arrest within hemodialysis clinics.
Modifications of the hemodialysis prescription may improve the risk of sudden cardiac arrest in patients with ESKD, and traditional risk factors such as history of coronary heart disease and congestive heart failure were not significantly influential.
Plasma potassium in patients with terminal renal failure during and after haemodialysis; relationship with dialytic potassium removal and total body potassium.
A rather high dialytic removal of potassium (which is correlated with plasma K x TBK) does not necessarily prevent a rapid postdialysis rebound of plasma K, which can be normal in haemodialysis patients who are well nourished.
Prolonged therapy with ACE inhibitors induces a regression of left ventricular hypertrophy of dialyzed uremic patients independently from hypotensive effects.
The effects of angiotensin converting enzyme inhibitors on potassium homeostasis in dialysis patients with and without residual renal function.
Hyperkalemia is exacerbated by angiotensin converting enzyme inhibitors (ACE-I). Distal potassium (K(+)) secretion is negligible in anuric patients. ACE-I therapy may reduce renal, peritoneal, and
Hyperkalemia in Dialysis Patients
This article reviews extrarenal potassium homeostasis and its alteration in patients with end‐stage renal disease and pays particular attention to the factors that influence the movement of potassium across cell membranes.
Variability in potassium removal by hemodialysis.
The large, unexplained variability in potassium removal suggests that therapeutic manipulation of potassium flux across cell membranes may improve the management of potassium balance in hemodialyzed patients.