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Korean J Nephrol. 2000 Jan;19(1):106-111. Korean. Original Article.
Kim JY , Roh KH , Ryu JH , Moon JD , Lee KW , Park IG , Kim HJ .
Department of Internal Medicine, Hanyang University Kuri Hospital, Kuri, Korea.
Department of Hemodialysis Unit, Hanyang University Kuri Hospital, Kuri, Korea.
Department of Clinical Pathology, Hanyang University Kuri Hospital, Kuri, Korea.
Abstract

To evaluate potassium(K) homeostasis during in-terdialytic and dialytic phases in chronic hemodialysis patients, we analyzed pre- and post- dialysis plasma K concentration(n=28) over n week with an interdialytic interval of 7Zhrs, 48hrs(l), and 48hrs(II), respectively, and the quantity of total dialytic K removal via dialysate. The predialysis plasma K at 72h interval(prePK72h: 4.89+/-0.17mEq/L) was significantly higher than those at 48h interval(prePK48h-I: 4.57+/-0.15mEq/L, and prePK48h-II: 4.40+/-15mEq/L) (p=0.000, p=0.000). 10.7% in prePK72h were categorized into severe hyperkalemia more than 6.0mEq/L, but none in prePK48h-I, II(p=0.000, p=0.000). In contrast no difference between 72-h and 42-h intervals was found in the postdialysis plasma K(postPK72h: 3.59+/-0.07 vs postPK48h-I : 3.530+/-08mEq/L, p>0.05) and in the quantity of total dialytic K removal via dialysate(delta Ktota172h : 74+/-2.6 vs delta Ktota148h-I:71+/-2.2mEq, p>0.05). On approach to this with two-compartment model, there was significant difference in dialytic K removal from ECF(delta Kecf72h:22.2+/-1.6 vs delta Kecf48h-I:17.7+/-1.6mEq, p<0.01), but not in that from ICF(delta Kicf72h:51.6+/-3.1 vs delta Kicf48h-I: 53.5+/-2.7mEq, p>0.05). In all 28 patients, age, sex and body weight were not correlated with either pre- and post- plasma K levels or total K removal per kg body weight. In conclusion, the majority of dialytic K removal is from the replenishment of the ICF potassium and it has rather constant feature in that there was no autoregulatory increment even with the higher predialysis plasma K concentration. So the plasma K concentration on chronic maintenace hemodialysis is more dependent on the potassium gain during interdialytic phase than the potassium removal during dialytic phase. Also it is reasonable to restrict dietary K intake and apply K-exalate orientating to the interdialytic phase of 72hrs because severe hyperkalemia is rare in that of 48hrs.

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