Electrolyte Blood Press.  2009 Jun;7(1):25-30. 10.5049/EBP.2009.7.1.25.

Comparison of Icodextrin and 2.5% Glucose in Potassium Metabolism by Acute K+oad via Dialysate in Continuous Ambulatory Peritoneal Dialysis Patients

• Yi JH
• Yun YW
• Han SW
• Kim HJ

• KMID: 1464786
• DOI: http://doi.org/10.5049/EBP.2009.7.1.25

Abstract

This study aimed to compare the increment in plasma potassium concentration ([K+]) as well as the role of internal K+ balance for its changes following acute K+ supplementation between conventional 2.5% glucose (GD) and non-glucose containing dialysate (icodextrin, ID) in continuous ambulatory peritoneal dialysis (CAPD) patients. A total of 9 stable CAPD patients (5 men and 4 women; age, 56+/-13 years; 7 type-2 diabetics and 2 non-diabetics) on daily 4 exchanges of 2 L of glucose dialysate underwent the 6-hr dwell on fasting in the morning with 2 L of 2.5% glucose mixed with 20 mEq/L of KCl, and then the same regimen was repeated with icodextrin after 1-wk interval. The degree of intraperitoneal absorption was comparable, 65+/-2% in GD and 68+/-2% in ID, respectively (p=NS). However, despite the similar plasma K+ levels at the baseline of both regimens, its increment was significantly less in GD than ID, which was accompanied by more marked increase in the calculated intracellular K+ redistribution (68+/-3% vs. 52+/-3%, p<0.05). The basal levels of insulin were similar between the GD and ID groups. However, the change, checked up after 2 hours' dwell, from the basal insulin levels was much lower on ID. ID with a lesser degree of transcelluar K+ shift by the decreased secretion of insulin is more effective than the conventional glucose solution for acute K+ repletion via dialysate during CAPD. Furthermore, these results suggested that the role of insulin for the internal K+ balance was intact even in type-2 diabetic patients on CAPD

Keyword

hypokalemia; peritoneal dialysis, continuous ambulatory; potassium supplementation; icodextrin

MeSH Terms

Absorption
Fasting
Glucans
Glucose
Humans
Hypokalemia
Insulin
Male
Peritoneal Dialysis, Continuous Ambulatory
Plasma
Potassium
Glucans
Glucose
Insulin
Potassium

Figure

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  Fig. 1 Comparison of increments in the plasma potassium concentrations ([K+]) between Icodextrin and 2.5% glucose solution following intraperitoneal administration of K+ (20 mEq/L) in CAPD patients (n=9). CAPD, continuous ambulatory peritoneal dialysis.

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  Fig. 2 Comparison of the absorbed K+ between Icodextrin and 2.5% glucose solution following intraperitoneal administration of K+ (40 mEq in 2 L) in nine CAPD patients. CAPD, continuous ambulatory peritoneal dialysis.

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  Fig. 3 Comparison of the translocated K+ to intracellular fluid between Icodextrin and 2.5% glucose solution following intraperitoneal administration of K+ (40 mEq in 2 L) in CAPD patients (n=9). CAPD, continuous ambulatory peritoneal dialysis.

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  Fig. 4 Comparison of changes in the plasma insulin levels between Icodextrin and 2.5% glucose solution at 2-hr dwell following intraperitoneal administration of potassium in CAPD patients (n=9). CAPD, continuous ambulatory peritoneal dialysis.

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