title: Optimizing dialysate potassium.
abstract: Potassium shifts in thrice weekly HD patients are likely a reversible cause of arrhythmia and sudden cardiac death. In general, a dialysate potassium <2.0 mmol/L should be avoided, and many patients with dialysate potassium of 2 mmol/L could safely be adjusted upwards. The ideal predialysis serum potassium should be around 5.0 mmol/L. Trends in serum potassium and not single values, should inform chronic changes of dialysate potassium prescription. Atypical values should be dealt with as a one off, but should not lead to chronic bath changes. Referral to a renal dietician for counseling to limit dietary potassium intake is vital to prevent recurrence of these atypical episodes. Finally, facilities should develop and implement a formal and reliable way to alert the physician about possible potassium bath mismatching. This facility level approach works best if a policy is developed and endorsed by all involved stakeholders.
authors.affiliation: Humber River Hospital, Toronto, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lee
authors.affiliation: Humber River Hospital and University of Toronto, Toronto, Canada. dmendelssohn@hrh.ca.
authors.forename: David C
authors.initials: DC
authors.lastname: Mendelssohn
mesh_terms: D000369:Aged, 80 and over; D015314:Dialysis Solutions / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D011188:Potassium / Q000097:blood*; D006435:Renal Dialysis / Q000379:methods*
chemical_list: D015314:Dialysis Solutions; D011188:Potassium
keywords: Quality improvement; cardiovascular; complications; medical director issues; patient safety