Potassium abnormality in PD

Q: Which of the following electrolyte abnormality is more common in peritoneal dialysis (PD) patients?

A) Hypokalemia
B) Hyperkalemia


Answer: A

Contrary to hemodialysis (HD) patients, hypokalemia is more common in PD patients and actually may require regular potassium repletion. For not fully understood reason, African-American patients are more prone to it. 

This paradox effect in renal patients is due to two reasons: 

1. Intraperitoneal dialysate carries glucose load resulting in subsequent insulin release and increases cellular uptake of potassium. 

2. PD patients have increase bowel potassium loss due to the chemical composition of dialysate. 

This hypokalemia is not fully benign and can be fatal particularly in the first year of the PD.


#nephrology
#electrolyteimbalance


References: 

1. Khan AN, Bernardini J, Johnston JR, Piraino B. Hypokalemia in peritoneal dialysis patients. Perit Dial Int 1996; 16:652. 

2. Xu Q, Xu F, Fan L, et al. Serum potassium levels and its variability in incident peritoneal dialysis patients: associations with mortality. PLoS One 2014; 9:e86750. 

3. Torlén K, Kalantar-Zadeh K, Molnar MZ, et al. Serum potassium and cause-specific mortality in a large peritoneal dialysis cohort. Clin J Am Soc Nephrol 2012; 7:1272.