Hypokalemia and hyperkalemia in patients on peritoneal dialysis: incidence and associated factors

Background Hypokalemia is a well-described electrolyte disturbance in patients on peritoneal dialysis (PD). Hyperkalemia, however, is still overlooked, although it also represents a risk factor for mortality. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (ACE/ARB), di...

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Published in:	International urology and nephrology Vol. 52; no. 2; pp. 393 - 398
Main Authors:	Goncalves, Fernanda A., de Jesus, Jessica Santos, Cordeiro, Lilian, Piraciaba, Maria Clara T., de Araujo, Luiza K. R. P., Steller Wagner Martins, Carolina, Dalboni, Maria Aparecida, Pereira, Benedito J., Silva, Bruno C., Moysés, Rosa Maria A., Abensur, Hugo, Elias, Rosilene M.
Format:	Journal Article
Language:	English
Published:	Dordrecht Springer Netherlands 01-02-2020 Springer Nature B.V
Subjects:	Adult Aged Angiotensin Angiotensin-converting enzyme inhibitors Anuria - complications Continental Population Groups Diuretics Female Furosemide Humans Hyperkalemia Hyperkalemia - blood Hyperkalemia - epidemiology Hyperkalemia - etiology Hypokalemia Hypokalemia - blood Hypokalemia - epidemiology Hypokalemia - etiology Incidence Male Medicine Medicine & Public Health Middle Aged Nephrology Nephrology - Original Paper Omeprazole Omeprazole - therapeutic use Peptidyl-dipeptidase A Peritoneal dialysis Peritoneal Dialysis - adverse effects Peritoneum Potassium Potassium - blood Protective Factors Proton pump inhibitors Proton Pump Inhibitors - therapeutic use Retrospective Studies Risk Factors Serum Albumin - metabolism Urology Hyperkalemia Anuria Black race Potassium Proton-pump inhibitor
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Summary:	Background Hypokalemia is a well-described electrolyte disturbance in patients on peritoneal dialysis (PD). Hyperkalemia, however, is still overlooked, although it also represents a risk factor for mortality. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (ACE/ARB), diuretics, and proton pump inhibitor (PPI) can interfere with potassium levels in these patients. Methods This is a retrospective study that evaluated monthly serum potassium in a 5-year period. Serum potassium disturbances were evaluated as time-average and number of hypo- and hyperkalemia episodes per patient. Prescribed medication such as ACE/ARB, diuretics, and omeprazole were recorded. Results We evaluated 2025 potassium measurements obtained from 146 patients on PD. Serum potassium ranged from 2.5 to 8.3 mEq/L with an average of 4.72 ± 0.74 mEq/L. Hypokalemia was found in 59 measurements (2.9%) obtained from 35 patients (23.9%) whereas hyperkalemia was demonstrated in 269 (13.3%) measurements obtained from 74 patients (50.7%). Hypokalemia was associated with low albumin ( p = 0.022), and omeprazole use ( p = 0.024). Black race was a protector factor ( p = 0.031). Omeprazole-associated hypokalemia was seen only in non-anuric patients and remained an independent risk factor even after adjustments. Patients who had hyperkalemia were more likely to be anuric ( p = 0.001) and in use of furosemide ( p = 0.0001). Conclusion Hyperkalemia and hypokalemia are very frequent in patients on PD and should be closely monitored. Interventional studies should address the impact of discontinuing omeprazole in the levels of potassium.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0301-1623 1573-2584
DOI:	10.1007/s11255-020-02385-2