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The Effects of Angiotensin Converting Enzyme Inhibitors on Potassium Homeostasis in Dialysis Patients With and Without Residual Renal Function
Author(s) -
Garthwaite Elizabeth,
Bhandari Sunil
Publication year - 2009
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.2009.00790.x
Subject(s) - peritoneal dialysis , medicine , hemodialysis , hyperkalemia , endocrinology , excretion , urology , renal function , angiotensin converting enzyme , dialysis , urinary system , gastroenterology , blood pressure
Hyperkalemia is exacerbated by angiotensin converting enzyme inhibitors (ACE‐I). Distal potassium (K + ) secretion is negligible in anuric patients. ACE‐I therapy may reduce renal, peritoneal, and colonic K + losses. We examined the effect of ACE‐I therapy on serum, urinary, and dialysate K + in a cross‐section of peritoneal and hemodialysis patients. Serum, 24‐h urine K + , and peritoneal dialysate excretion K + levels were measured and the results were compared in the various dialysis and treatment groups. Eighty‐one hemodialysis (HD) and 32 peritoneal dialysis (PD) patients were included. Serum K + in HD patients with no residual renal function (RRF) was higher in those receiving ACE‐I therapy ( P = 0.02). Serum K + levels in HD patients receiving ACE‐I treatments with RRF was similar to that in oligoanuric HD patients not receiving an ACE‐I. Urinary K + excretion was significantly reduced in those on ACE‐I therapy versus those not on an ACE‐I ( P < 0.05). Mean serum K + was lower in PD versus HD patients ( P < 0.05). PD patients with no RRF on ACE‐I therapy had higher serum K + concentrations ( P = 0.002) and dialysate K + excretion was lower ( P = 0.05), in comparison with PD patients not on an ACE‐I. PD patients with RRF on ACE‐I therapy had higher serum K + concentrations compared with those not on ACE‐I therapy ( P = 0.03). Both urinary and dialysate K + excretion were reduced ( P = 0.001 and P = 0.002, respectively). ACE‐I therapy increases serum K + concentration in dialysis patients. PD patients have relatively lower serum K + levels compared with HD patients. In PD patients, ACE‐I therapy reduces dialysate K + . These changes may result from reduced peritoneal movement of K + .