Premium
High [K + ] Dialysate (3mEq/l) Improves Survival in Hemodialysis (HD) Patients
Author(s) -
Khraish GH,
Adrogue HJ.,
Dolson GM.
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.01247.x
Subject(s) - medicine , hypokalemia , hyperkalemia , hemodialysis , mortality rate , incidence (geometry) , urology , surgery , gastroenterology , optics , physics
: Excessive K + removal and hypokalemia following HD with standard bath (K + 2 mEq/L) might be responsible for elevated cardiovascular risk in end‐stage renal disease (ESRD) patients. In support of this contention, we have previously documented that HD using a dialysate [K + ] of 3.0 mEq/L increases urea removal (JASN 9:2124, 1998) and lowers rebound hypertension (AJKD 26:321, 1995) after treatment, while minimizing K + deficiency. Objective : To compare 1) expected death rate with standard bath to study protocol; and 2) mortality rates within our unit when [K + ]d was changed from 2 mEq/L to 3 mEq/L. Methods : 57 patients received HD with standard dialysate [K + ] concentration of 2.0 mEq/L through May, 2000. Starting in June, 2000, standard [K + ] bath was changed to 3.0 mEq/L. Other treatment parameters remained unchanged. Results : As shown in the figure, the actual death rate decreased coincident with the change in [K + ] bath, even though the expected death rate, corrected for patient age, sex, race, and incidence of diabetes, increased slightly. Hyperkalemia did not occur after dialysate [K + ] was increased, with average pre‐HD serum [K + ] of 4.76 ± 0.48 mmol/L. Conclusion : Routine use of dialysate [K + ] of 3 mmol/L is associated with improved survival in patients with ESRD.