Controlled potassium reduction using dialysate profiling in hyperkalemic hemodialysis patients: A randomized study

The ideal dialysate potassium concentration for patients with hyperkalemia undergoing maintenance hemodialysis is debated. While low-potassium dialysate enhances potassium removal, a steep serum-todialysate potassium gradient may provoke arrhythmias. This study aimed to assess the efficacy of a two-phase dialysate potassium profiling strategy.

Patients aged 18-60 years with end-stage renal disease and predialysis hyperkalemia were randomized into two groups for twice-weekly hemodialysis. Group A received 2 mEq/L potassium dialysate for the first hour, followed by 0 mEq/L for the next 3 h. Group B received a constant 2 mEq/L potassium dialysate throughout the 4-h session. Serum potassium was measured pre-dialysis and hourly during the session. Patients were monitored for cardiac arrhythmias.

Of 145 patients screened, 60 were enrolled (30 per group). The majority were male (66.7% in Group A and 56.7% in Group B), with over 50% having diabetes and 85% hypertension, indicating high cardiovascular risk. Predialysis potassium levels were similar (6.00 ± 0.3 mEq/L in Group A vs 5.98 ± 0.34 mEq/L in Group B). Group A achieved significantly lower post-dialysis potassium levels (3.48 ± 0.22 mEq/L) than Group B (3.72 ± 0.42 mEq/L; p = 0.008). One case of ventricular ectopy was observed in each group, both managed conservatively.

Two-phase dialysate potassium profiling effectively lowers serum potassium more than a fixed approach, without a significant increase in arrhythmic events, supporting its use in managing hyperkalemia in hemodialysis patients.