Comparison of Aminophylline and Insulin Infusions in Treatment of Hyperkalemia in Patients with End-Stage Renal Disease

Kenan Ateş, MD, Başçavuş Sokak 19/10, 06660 Seyranbaǧlari, Ankara (Turkey) Table 1. Mean plasma potassium levels before and after aminophylline (group A) or insulin (group B) infusions in hyperkalemic patients Group A Group B P > * p < 0.001 vs. before treatment; ** p < 0.0001 vs. before treatment. Dear Sir, Hyperkalemia is a frequent encountered problem in patients with chronic renal failure (CRF). The principal cause of hyperkalemia is reduced renal potassium excretion, but the extrarenal potassium homeostasis may also be impaired [1]. Besides dialysis, it can be treated effectively with intravenous administration of insulin and glucose. Beta-adrenergic agonists that facilitate intracellu-lar potassium uptake may be a cause of hypokalemia [2]. Several studies have reported a decrease in plasma potassium levels in uremic patients treated with salbutamol, a ß2-adrenergic agonist [3-5]. In this study, we examined effectiveness of aminophylline, a methylxanthine derivative, in the treatment of hyperkalemia in patients with CRF. Forty-five patients with CRF whose plasma potassium level was higher than 6 mEq/1 were included in the study. None of these patients was taking digitalis, ß-blockers, insulin or ßadrenergic agonist, and was known to have asthma, diabetes mellitus or heart disease. Twenty-five patients, 15 male and 10 female, were treated with 480 mg aminophylline in 100 ml of 0.9% NaCl solution administered intravenously over a period of 30 min (group A). Twenty patients, 12 male and 8 female, were treated with 10 units of regular insulin in 100 ml of 30% dextrose solution infused over a period of 30 min (group B). Immediately before, and 60, 180 and 360 min after the infusions, blood pressure, heart rate, plasma potassium, sodium, glucose and creatinine levels were measured. Results are expressed as mean ± SD.