Korean J Nephrol.  1999 Nov;18(6):940-946.

The Immediate Transcompartmental Shifts of Potassium following Hemodialysis in Chronically Hyperkalemic Patients on Maintenance Hemodialysis

• Han SW
• Lee KW
• Kim HJ
• Kim TY
• Kim KC
• Yoo YJ
• Oh SJ
• Park IK

Abstract

Hernodialysis(HD) patients are continuously exposed to hyperkalemia, the degree of which depends on the amount of dialysate potassium(K) removal and intra- compartmental K shifts besides poor dietary K compli- ance. Chronically hyperkalemic outpatients(n=20) on chronic hernodialysis by routine monthly serum potassium(SK) concentration measurements(SK> or =5.1mEq/L, more than 4 times in 6 months) was looked for the derangements of short-term interval K handling by observing the pattern of change in plasma K(PK) thru HD. In all 20 patients, as expected, the predialysis PK(PKo, 5.3 +/- 0.16mEq/L) were significantly correlated with the end-dialysis PK(PKe, 3.8+/-0.09mEq/l.)(r=0.65, p<0.01) and the magnitude of the fall in PK(PKo-PKe, 1.6+/-0.55mEq/L)(r=0.85, p<0.0001). Also, PKo were ne- gatively correlated with anion gap(r=-0.50, p<0.05) and plasma Na level(r=-0.69, p<0.01). PK at 2 hours after HD(PKr, 4.6+/-0.13mEq/L) revealed a marked post- dialytic K rebound. PKr correlated with PKe, whereas no significant correlation between the magnitude of the rise in PKe(PKr-PKe) and PKe was found. Of 20 hyperkalemic patients, PK of 9 patients(group I), sur- prisingly, showed normokalemia(4.7+/-0.09mF) and that of 11(group II) showed true hyperkalernia(5.8>0.19 mEq/L). Between 2 groups, significant differences were found in plasma Na level(140 +/- 0.8 vs. 1360.7mEq/L, p<0.01) and the percentage of(PKr-PKe) divided by PKe(141.8 vs. 272.5Yo, p<0.01), but no difference in anion gap, pH, albumin, creatinine, and(PKo-PKe) divided by PKO, respectively. Based on this data, we conclude that hyperkalemic hemodialysis patients should be confirmed by plasma K determination to exclude factitious hyperkalemia, and they may have the derangements of internal K balance due to transcompartmental K shifts following HD, which would be partly related to that of Na balance.

MeSH Terms

Acid-Base Equilibrium
Creatinine
Humans
Hydrogen-Ion Concentration
Hyperkalemia
Plasma
Potassium*
Renal Dialysis*
Creatinine
Potassium