A multicenter study of hemodialysis using individualized dialysate potassium concentrations

Area of Science:

• Nephrology
• Clinical Chemistry

Background:

• Dialysate potassium concentration critically impacts hemodialysis patient safety.
• Current practice in China often uses a single dialysate potassium concentration without clear evidence of its appropriateness.

Purpose of the Study:

• To evaluate the safety and efficacy of a uniform dialysate potassium concentration (KD) of 2.0 mmol/L in maintenance hemodialysis (MHD) patients.
• To assess the impact of individualized KD on serum potassium levels and hypokalemia incidence.

Main Methods:

• Retrospective analysis of serum potassium data from 1,296 MHD patients across 5 Shanghai centers (2019-2020).
• Data collected pre- and post-dialysis, with 3 measurements per patient.
• Comparison of outcomes between uniform KD 2.0 mmol/L and individualized KD in 668 patients.

Main Results:

• Significant proportions of patients exhibited pre-dialysis hypokalemia (<4.5 mmol/L) and hyperkalemia (>5.5 mmol/L).
• Post-dialysis hypokalemia (<3 mmol/L) was observed in 11.3% of patients.
• Individualized KD significantly reduced post-dialysis hypokalemia and the overall incidence of low pre- and post-dialysis serum potassium levels.

Conclusions:

• A uniform dialysate potassium concentration of 2.0 mmol/L is insufficient for all MHD patients.
• Individualized KD effectively reduces hypokalemia in MHD patients, particularly those with low baseline serum potassium.
• Personalized dialysate potassium management is crucial for patient safety in hemodialysis.