Subcutaneous terbutaline use in CKD to reduce potassium concentrations

Acute hyperkalemia is a frequent and potentially life-threatening medical problem in patients on maintenance hemodialysis therapy. beta-Adrenergic receptor (betaAR) stimulation causes potassium cellular influx and a decline in plasma potassium concentrations. Therefore, betaAR agonists are used in the treatment of patients with hyperkalemia. The goal of this study is to evaluate the utility of weight-based subcutaneous terbutaline dosing to reduce plasma potassium concentrations in a group of subjects with chronic kidney disease (CKD) requiring hemodialysis.

Fourteen subjects with CKD receiving long-term hemodialysis were administered terbutaline, 7 microg/kg, subcutaneously. Heart rate measurements and blood samples for potassium concentration determinations were made serially for 420 minutes. Effects of terbutaline on heart rate and potassium responses were determined in each subject.

Terbutaline significantly reduced plasma potassium concentrations and significantly increased heart rates during the time course of the study (P < 0.001, repeated-measures analysis of variance). Mean reduction in peak potassium concentration (-1.31 +/- 0.5 [SD] mEq/L) and increase in peak heart rate (25.8 +/- 10.5 beats/min) were significantly different from baseline (P < 0.001, baseline versus peak for both responses). No subject reported significant adverse effects.

Administration of subcutaneous terbutaline obviates the need for intravenous access and should be considered as an alternative to nebulized or inhaled beta-agonists to treat acute hyperkalemia in patients with CKD. As with the use of any beta-adrenergic agonist, close cardiovascular monitoring is necessary to avoid or minimize toxicity during therapy.