Optimizing dialysate potassium

Potassium shifts in thrice weekly HD patients are likely a reversible cause of arrhythmia and sudden cardiac death. In general, a dialysate potassium <2.0 mmol/L should be avoided, and many patients with dialysate potassium of 2 mmol/L could safely be adjusted upwards. The ideal predialysis serum potassium should be around 5.0 mmol/L. Trends in serum potassium and not single values, should inform chronic changes of dialysate potassium prescription. Atypical values should be dealt with as a one off, but should not lead to chronic bath changes. Referral to a renal dietician for counseling to limit dietary potassium intake is vital to prevent recurrence of these atypical episodes. Finally, facilities should develop and implement a formal and reliable way to alert the physician about possible potassium bath mismatching. This facility level approach works best if a policy is developed and endorsed by all involved stakeholders.