The Influence of Nonselective Beta-Adrenergic Blockade (carteolol) and ACE Inhibitor (captopril) in Plasma Potassium on Maintenance hemodialysis

Lee, Jae Ung; Lee, Oh Young; Yang, Suck Chul; Han, Dong Soo; Sohn, Joo Hyun; Kim, Soon Kil; Kim, Ho Jung; Koh, Hee Kwan; Jung, Ja Hun; Nam, Seung Woo; Paik, In Kyu; Lee, Chang Beom

Abstract

OBJECTIVES
The degree of hyperkalemia and effects of potassium removal by hemodialysis on the plasma potassium concentration to see the influence of nonselective beta-adrenergic blockade(carteolol) and ACE inhibitor(captopril) on patients in maintenance hemodialysis were evaluated.
METHODS
This study was done on 16 patients with end-stage renal disease undergoing maintenance hemodialysis. These patients were classified two groups; group 1-patients with carteolol or captopril(9 patients) and group 2-patients without medication(7 patients). Measurement of plasma potassium and arterial blood gas analyses were performed at pre-dialysis and during hemodialysis(4 hours). To analysis the distribution of potassium kinetics during hemodialysis, dialysis potassium clearance rate was introduced in this study.
RESULTS
1) Among 16 patients studied, the mean age was 43 years old and the ratio of male to female was 2: 1 and the mean duration of hemodialysis was 17.9 months. The underlying cause of end-stage renal disease was chronic glomerulonephritis in the most patients. 2) The mean predialysis plasma potassium concentration of all patients, group 1 on medication, and group 2 without medication was 5.13 +/- 1.04mEq/L, 5.67 +/- 1.01mEq/L and 4.410.55mEq/L, with high significance(p<0.001) between groups 1 and 2. 3) The mean postdialysis plasma potassium concentration of group 1 on medication and group 2 without medication was 348 +/- 0.40mEq/L and 3.39 +/- 0.56mEq/L with insignificance between groups 1 and 2. 4) The pre- and post-dialysis concentration of plasma sodium, pH and bicarbonate between group 1 and group 2 was similar except glucose. 5) Despite the fall in absolute plasma concentration in group 1 more than twice than in group 2, the difference in dialysis potassium clearance rate measured at 1 hour of hemodialysis in group 1 compared to that of group 2 was only 12M.
CONCLUSION
These data are consistent with at least a two-compartment distribution of plasma potassium rather than single pool in addition to frequent hyperkalemia on maintenance hemodialysis on nonselective beta-adrenergic blocker or ACE inhibitor contributed to partial impairment of extrarenal transcellular shifts of potassium during inter- and intra-dialytic phase.