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. To evaluate the role of plasma tonicity in the postdialysis increment of plasma potassium (p[K + ]), the outcome of two hemodiafiltration treatments that differed only in the Na +  level in dialysate (Na D )—143 mmol/L (high dialysate sodium concentration [H-Na D ]) and 138 mmol/L (low dialysate sodium concentration [L-Na D ])—were compared in the same group of uremic patients from the end of treatment (T0) to the subsequent 30 to 120 min and up to 68 h. Kt/V and intradialytic K +  removal were comparable. At T0, plasma [Na + ] was 145 ± 1 and 137 ± 1 mmol/L after H-Na D  and L-Na D , respectively ( P  &lt; 0.001). The difference in plasma tonicity persisted from T0 to T68 h. At T120, p[K + ] was increased from the T0 value of 3.7 ± 0.2 to 4.7 ± 0.2 mmol/L ( P  &lt; 0.05) after H-Na D , whereas it was unchanged after L-Na D . The change of p[K + ] was still different after 68 h (+76 ± 10% and +50 ± 7% in H-Na D  and L-Na D , respectively;  P  &lt; 0.05). Of note, in the first 2 h after the end of treatment, bioimpedance analysis revealed only in H-Na D  a significant 11 ± 3% decrement of phase angle that is compatible with a decrease of intracellular fluid volume at the expense of the extracellular volume. Similarly, within the same time frame, in H-Na D , a significant reduction of mean corpuscular volume of red cells, associated with a 2 ± 1% decrease of the intracellular [K + ], was observed. In contrast, mean corpuscular volume of red cells did not change and erythrocyte [K + ] increased by 6 ± 1% after L-Na D  ( P  &lt; 0.005  versus  H-Na D ). Thus, hypertonicity significantly contributes to the increase of p[K + ] throughout the whole interdialytic period by determining intracellular fluid volume/extracellular volume redistribution of water and K + .

Effect of Dialysate Sodium Concentration on Interdialytic Increase of Potassium