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Predictors of hyperkalemia in pediatric patients on dialysis: international prospective observational study
Fabio Paglialonga1, Rukshana Shroff2, Ilona Zagozdzon3
1Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy. fabio.paglialonga@policlinico.mi.it.
Insights
Hyperkalemia in children on dialysis is predicted by age, urea levels, and renin-angiotensin-aldosterone system inhibitors, not dietary potassium intake. This highlights non-dietary factors in managing potassium levels.
Area of Science:
- Pediatric Nephrology
- Clinical Biochemistry
- Renal Nutrition
Background:
- Hyperkalemia is a significant complication in pediatric patients with kidney failure.
- Effective management requires understanding its predictors in children undergoing maintenance dialysis.
Purpose of the Study:
- To identify independent predictors of hyperkalemia in children receiving chronic dialysis.
- To evaluate the role of dietary potassium intake versus other factors.
Main Methods:
- International prospective cross-sectional observational study of pediatric dialysis patients (<18 years).
- Hyperkalemia defined as serum potassium ≥5 mEq/L.
- Data collected included demographics, dialysis vintage, urine output, dietary intake, blood pressure, and biochemical parameters.
Main Results:
- Thirty-six-point-six percent of 41 enrolled patients had hyperkalemia.
- Independent predictors identified were older age, higher serum urea, and treatment with renin-angiotensin-aldosterone system inhibitors (RAASi).
- Dietary potassium intake was not significantly associated with serum potassium levels.
Conclusions:
- Age, urea levels, and RAASi treatment are key predictors of hyperkalemia in pediatric dialysis patients.
- Focusing on dietary potassium alone is insufficient; non-dietary factors and drug effects are crucial.
- Further research into potassium bioavailability is warranted.
Background:
Hyperkalemia is an important issue in kidney failure. The aim of the study was to investigate the predictors of hyperkalemia in children receiving maintenance dialysis.
Methods:
This was an international prospective cross-sectional observational study involving patients < 18 years receiving chronic hemodialysis or peritoneal dialysis. Hyperkalemia was defined as serum potassium (sK+) ≥ 5 mEq/L based on the Pediatric Renal Nutrition Taskforce recommendations. We recorded age, dialysis vintage, urine output (24-h urine collection); dietary K+, energy, protein and sodium intake (three-day diaries); office blood pressure (BP) in children < 5 years and 24-h ABPM in older patients; biochemistry (creatinine, urea, sodium, bicarbonate, hemoglobin, phosphate, albumin) and antihypertensive drugs.
Results:
Forty-one patients were enrolled (10 peritoneal dialysis, 31 hemodialysis), median age 13.3 (IQR 10.6-15.8) years; 15 of them (36.6%) showed hyperkalemia, and median sK+ was 4.7 (4.4-5.0) mEq/L. Renin-angiotensin-aldosterone system inhibitors (RAASi) were prescribed in 9/15 patients with hyperkalemia (60%) and 7/26 (26.9%) without hyperkalemia (p = 0.04). Patients with hyperkalemia were older and had higher urea and creatinine than those with normal sK+. A backward stepwise multivariable model showed that the only predictors of hyperkalemia were age (b = 0.53, p = 0.01), urea (b = 0.02, p = 0.03) and treatment with RAASi (b = 2.75, p = 0.021).
Conclusions:
While higher age, higher urea levels and treatment with RAASi independently predicted the occurrence of hyperkalemia, K+ intake was not associated with sK+ in children on dialysis. This emphasizes the importance of considering non-dietary causes of hyperkalemia and considering the bioavailability of K+ more than the total dietary K+ intake.
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