Potassium-lowering effect of mineralocorticoid therapy in patients undergoing hemodialysis

Abstract

Hyperkalemia is a frequent problem in patients with end stage renal d isease (ESRD), seen in about 10% of hemodialysis patients (Furuya et al., 2002). Sacchetti et aL (1999) reported that hyperkalemia was the reason for emergency dialysis 24% of the time i n their patients with ESRD on maintenance hemodialysis and attri buted 3-5% of deaths in dialysis patients to hyperkalemia. Because renal potassium excretion is essentiall y mini mal in ESRD patients, extrarenal potassium disposal should play an important role against hyperkalemia (Ahmed and Weisberg, 2001).

Many factors modulate the relati onship between serum K+ and total body K+ in patients with ESRD. Indeed, the amoun t of K+ removed duri ng a hemodialysis session appears to have a li ttle influence on the next predialysis serum K+. Nonetheless, persistent hyperkalemi a i n di al ysis patients is l i kely to be caused by disorders of external potassium balance; excessi ve K+ i n take most common ly d ue to dietary noncompliance, i nadequate K+ el im ination, or a combination of the two (Kaveh and Kimmel, 2001).

Inadeq uate di alysis either by prescr iption, non-compliance, or d ue to vascu lar access complications, i s a nother common pred i sposi tion to hyperka lemi a. Consti pation also depr i ves