A multicenter study of hemodialysis using individualized dialysate potassium concentrations.

BACKGROUND

Dialysate potassium concentration directly affects the serum potassium level and safety of hemodialysis patients. In most dialysis centers in China, a single dialysate potassium concentration is used for dialysis, but there is no data on whether this is reasonable or not.

METHODS

Serum potassium values before and after dialysis in maintenance hemodialysis (MHD) patients between 2019 and 2020 were collected from 5 hemodialysis centers in Shanghai, which uniformly use dialysate with a potassium concentration (KD) of 2.0 mmol/L, and data were collected 3 times per patient for analysis. Serum potassium fluctuation was analyzed after administration of individualized KD dialysate.

RESULTS

In all, 1,296 MHD patients were included in the study. Predialysis serum potassium was lower than 4.5 mmol/L in 38.0% and higher than 5.5 mmol/L in 14.6% of patients. Postdialysis serum potassium was lower than 3 mmol/L in 11.3% and higher than 4 mmol/L in 10.4% of patients. Pre-dialysis serum potassium was below 4.5 mmol/L and post- dialysis serum potassium was below 3 mmol/L in 9.54% of patients. Compared with patients younger than 40 years, patients >80 years more often exhibited predialysis serum potassium below 4.5 mmol/L and Postdialysis serum potassium below 3 mmol/L. A total of 668 patients underwent a trial of hemodialysis with individualized KD dialysate. When receiving individualized KD, compared with uniform KD 2.0 mmol/L, the number of patients with postdialysis serum potassium less than 3 mmol/L significantly decreased, the following predialysis serum potassium level was not significantly different from baseline, and the proportion of patients with predialysis serum potassium less than 4.5 mmol/L and postdialysis serum potassium less than 3 mmol/L significantly decreased.

CONCLUSIONS

Hypokalemia and fluctuations of serum potassium are common in MHD patients. KD 2.0 mmol/L dialysate should not be used for all patients, and individualized KD dialysate for patients with low serum potassium reduces the incidence of hypokalemia.