Nondialytic management of hyperkalemia and pulmonary edema among end-stage renal disease patients: an evaluation of the evidence.
Congestive heart failure (CHF) and hyperkalemia are the two leading reasons for emergency dialysis among individuals with end-stage renal disease (ESRD). While hemodialysis provides definitive treatment of both hyperkalemia and volume overload among ESRD patients, for those who present outside of "regular dialysis hours," institution of dialysis may be delayed. Nondialytic management can be instituted immediately and should be the initial therapy in the management of hyperkalemia and CHF in these individuals. Current available evidence does not allow conclusions as to whether treatment with nondialytic strategies alone results in different outcomes than nondialytic strategies coupled with emergent hemodialysis. Therefore, whether or not nondialytic management alone is appropriate remains a matter of individual judgment that should be decided on a case-by-case basis.
Evans
Kimberley
K
Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, North Carolina 27705, USA. evans122@mc.duke.edu
Reddan
Donal N
DN
Szczech
Lynda Anne
LA
D002118:Calcium / Q000627:therapeutic use; D002395:Catecholamines / Q000627:therapeutic use; D002411:Cation Exchange Resins / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology / Q000628:therapy*; D007328:Insulin / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications*; D011654:Pulmonary Edema / Q000209:etiology / Q000628:therapy*; D017693:Sodium Bicarbonate / Q000627:therapeutic use
D002395:Catecholamines; D002411:Cation Exchange Resins; D004232:Diuretics; D007328:Insulin; D017693:Sodium Bicarbonate; D005947:Glucose; D002118:Calcium