Diltiazem enhances potassium disposal in subjects with end-stage renal disease

Seven subjects with end-stage renal disease (ESRD) who were anuric and dialysis-dependent were studied during a 28-hour interdialytic period to assess changes in plasma potassium. Plasma potassium, glucose, magnesium, aldosterone, and cortisol were measured every 4 hours. Eight normal subjects were similarly treated. Subjects with ESRD had a progressive increase in plasma potassium, in contrast to normal subjects who exhibited a characteristic diurnal variation. In ESRD, diltiazem significantly reduced the rate of increase in plasma potassium compared with placebo and resulted in a significantly lower net increase in potassium over the entire 28-hour period. Diltiazem did not affect plasma potassium in normal subjects. Diltiazem did not affect plasma aldosterone, cortisol, glucose, or magnesium. In conclusion, diltiazem reduced the rate of increase of plasma potassium during a 28-hour interdialytic period.