Clinical Utility of Potassium-Sparing Diuretics to Maintain Normal Serum Potassium in Peritoneal Dialysis Patients.
♦ BACKGROUND: Hypokalemia is a vexing problem in end-stage renal disease patients on peritoneal dialysis (PD), and oral potassium supplements (OPS) have limited palatability. Potassium-sparing diuretics (KSD) (spironolactone, amiloride) may be effective in these patients. ♦ METHODS: We performed a cross-sectional review of 75 current or past (vintage > 6 months) PD patients with regard to serum potassium (K+), OPS, and KSD utilization. We reviewed charts for multiple clinical and laboratory variables, including dialysis adequacy, residual renal function, nutritional status and co-existing medical therapy. ♦ RESULTS: The cohort was middle-aged with a mean age of 49.2 years (standard deviation [SD] = 14.7) and overweight with a body mass index of 29.5 (6.7) kg/m2. Of all the participants, 57.3% were female, 73.3% African-American, and 48% diabetic with an overall PD vintage of 28.2 (24.3) months at the time of enrollment. Weekly Kt/V was 2.12 (0.43), creatinine clearance was 73.5 (33.6) L/week/1.73 m2with total daily exchange volume of 10.8 (2.7) L. Residual urine output (RUO) measured at 440 (494) mL (anuric 30.6%). Three-month averaged serum K+measured at 4 (0.5) mmol/L with 36% of the participants receiving K+supplements (median: 20 [0;20] mmol/day) and 41.3% KSD (spironolactone dose: 25 - 200 mg/day; amiloride dose: 5 - 10 mg/day). Serum K+correlated positively with weekly Kt/V (r = 0.239; p = 0.039), PD vintage (r = 0.272; p = 0.018) but not with PD modality, daily exchange volume, RUO, or KSD use. However, KSD use was associated with decreased use of OPS (r = -0.646; p < 0.0001). ♦ CONCLUSIONS: Potassium-sparing diuretics were effective in this cohort of PD patients and decreased the need for OPS utilization.
Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA tiborfulop.nephro@gmail.com.
Tibor
T
Fülöp
Department of Surgery, Division of Transplantation, University of Debrecen, Debrecen, Hungary.
Lajos
L
Zsom
Department of Medicine, Division of Hospital Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
Betzaida
B
Rodríguez
Department of Pediatrics, Division of Pediatric Nephrology, University of Mississippi Medical Center, Jackson, MS, USA.
Sabahat
S
Afshan
Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA.
Jamie V
JV
Davidson
Department of Mathematics, Louisiana State University Shreveport, LA, USA.
Tibor
T
Szarvas
Department of Pediatrics, Division of Pediatric Nephrology, University of Mississippi Medical Center, Jackson, MS, USA.
Mehul P
MP
Dixit
Fresenius Medical Care, Semmelweis University, Budapest, Hungary.
Mihály B
MB
Tapolyai
Institute of Pathophysiology, Semmelweis University, Budapest, Hungary.
László
L
Rosivall
D000328:Adult; D003430:Cross-Sectional Studies; D062865:Diuretics, Potassium Sparing / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007008:Hypokalemia / Q000209:etiology* / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D011188:Potassium / Q000097:blood*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States
D062865:Diuretics, Potassium Sparing; D011188:Potassium
Amiloride; end-stage renal disease; hypokalemia; peritoneal dialysis; potassium supplements; residual renal function; spironolactone