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The law of unintended consequences in action: increase in incidence of hypokalemia with improved adequacy of dialysis.
Adv Perit Dial 2000; 16:134-7AP

Abstract

In 1996, we raised our peritoneal dialysis (PD) dose to meet new DOQI adequacy targets. Concurrently, we noted an increase in the frequency of K+ levels below 3.5 mEq/L. A continuous quality improvement (CQI) project was initiated to quantify the impact of increasing dialysis dose on the prevalence of hypokalemia in our unit. Measurements of serum K+, blood urea nitrogen (BUN), creatinine, residual renal function, and the number and type of clinical interventions required to maintain eukalemia were abstracted from the charts of 62 patients enrolled in our program for more than 6 months and having more than two adequacy data points. In the seven consecutive 6-month periods from January 1996 to June 1999, dialysis dose progressively increased while median serum K+ decreased, and the percentage of patients requiring either diet counselling or K+ supplementation rose from 9% to 42%. We conclude that the increased clearance of K+ that occurs with increasing dialysis dose may lead to significant hypokalemia in a large proportion of PD patients dialyzed to DOQI adequacy targets. Maintenance of eukalemia in this population often requires increased K+ intake and or oral supplementation. Further studies are needed to ascertain whether the prevalence of hypokalemia is sufficient to warrant routine addition of K+ to PD dialysis solutions.

Authors+Show Affiliations

Department of Ambulatory and Support Services, University Hospitals of Cleveland, Ohio, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11045278

Citation

Newman, L N., et al. "The Law of Unintended Consequences in Action: Increase in Incidence of Hypokalemia With Improved Adequacy of Dialysis." Advances in Peritoneal Dialysis. Conference On Peritoneal Dialysis, vol. 16, 2000, pp. 134-7.
Newman LN, Weiss MF, Berger J, et al. The law of unintended consequences in action: increase in incidence of hypokalemia with improved adequacy of dialysis. Adv Perit Dial. 2000;16:134-7.
Newman, L. N., Weiss, M. F., Berger, J., Priester, A., Negrea, L. A., & Cacho, C. P. (2000). The law of unintended consequences in action: increase in incidence of hypokalemia with improved adequacy of dialysis. Advances in Peritoneal Dialysis. Conference On Peritoneal Dialysis, 16, pp. 134-7.
Newman LN, et al. The Law of Unintended Consequences in Action: Increase in Incidence of Hypokalemia With Improved Adequacy of Dialysis. Adv Perit Dial. 2000;16:134-7. PubMed PMID: 11045278.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The law of unintended consequences in action: increase in incidence of hypokalemia with improved adequacy of dialysis. AU - Newman,L N, AU - Weiss,M F, AU - Berger,J, AU - Priester,A, AU - Negrea,L A, AU - Cacho,C P, PY - 2000/10/25/pubmed PY - 2001/2/28/medline PY - 2000/10/25/entrez SP - 134 EP - 7 JF - Advances in peritoneal dialysis. Conference on Peritoneal Dialysis JO - Adv Perit Dial VL - 16 N2 - In 1996, we raised our peritoneal dialysis (PD) dose to meet new DOQI adequacy targets. Concurrently, we noted an increase in the frequency of K+ levels below 3.5 mEq/L. A continuous quality improvement (CQI) project was initiated to quantify the impact of increasing dialysis dose on the prevalence of hypokalemia in our unit. Measurements of serum K+, blood urea nitrogen (BUN), creatinine, residual renal function, and the number and type of clinical interventions required to maintain eukalemia were abstracted from the charts of 62 patients enrolled in our program for more than 6 months and having more than two adequacy data points. In the seven consecutive 6-month periods from January 1996 to June 1999, dialysis dose progressively increased while median serum K+ decreased, and the percentage of patients requiring either diet counselling or K+ supplementation rose from 9% to 42%. We conclude that the increased clearance of K+ that occurs with increasing dialysis dose may lead to significant hypokalemia in a large proportion of PD patients dialyzed to DOQI adequacy targets. Maintenance of eukalemia in this population often requires increased K+ intake and or oral supplementation. Further studies are needed to ascertain whether the prevalence of hypokalemia is sufficient to warrant routine addition of K+ to PD dialysis solutions. SN - 1197-8554 UR - https://www.unboundmedicine.com/medline/citation/11045278/full_citation L2 - http://www.diseaseinfosearch.org/result/3659 DB - PRIME DP - Unbound Medicine ER -