Angelo Karaboyas

Examining serum and dialysate potassium in hemodialysis

When a dialysis session becomes unstable, the result can sometimes be sudden cardiac death, which is a leading cause of death in patients on maintenance hemodialysis. During hemodialysis sessions, rapid electrolytes shifts can occur, which may contribute to arrhythmias and sudden death. While high pre-dialysis serum potassium is recognized as a risk factor for sudden death and all-cause mortality in hemodialysis patients, the results of studies examining the effects of dialysate potassium have been mixed.

Using data from 55,183 patients from 20 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS), researchers reexamined the risks of different dialysate potassium prescriptions and explored the associations between pre-dialysis serum potassium levels and outcomes as well as the association between dialysate potassium and serum potassium.

Consistent with prior studies, they found that high serum potassium was associated with increased all-cause mortality and arrhythmia/sudden death. However, they found minimal difference in the risk of adverse events between a dialysate potassium prescription of 3 vs. 2 mEq/L, at any given serum potassium level. They also found only minimal impact of dialysate potassium on pre-dialysis serum potassium.

“We cannot provide a recommendation for any immediate changes in practice based on our null findings, though in the long term, our results support equipoise for future research of an easily modifiable practice pattern in a randomized setting,” said lead author Angelo Karaboyas.

The authors conclude that approaches other than altering dialysate potassium concentration (e.g., education to reduce dietary potassium intake, prescription of potassium-binding medications) may merit further attention to reduce risks such as sudden death.


Karaboyas A, Zee J, Brunelli SM, Usvyat LA, Weiner DE, Maddux FW, Nissenson AR, Jadoul M, Locatelli F, Winkelmayer WC, Port FK, Robinson BM, Tentori F. Dialysate Potassium, Serum Potassium, Mortality and Arrhythmia Events in Hemodialysis: Results from the DOPPS. Am J Kidney Dis. 2017;69(2):266-277.

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November 21, 2016 
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