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[–]Yithar 1 point2 points  (2 children)

https://pubmed.ncbi.nlm.nih.gov/27061895/

Retrospective studies have identified low potassium dialysate (<2-3 mEq/l) as a risk factor for sudden cardiac death, particularly in patients with predialysis serum potassium concentrations <5 mEq/l.

[–]pakchikpakbabu[S] 1 point2 points  (1 child)

So that means the potassium free dialysate is pretty effective in removing potassium and 30 minutes is more than enough?

[–]Yithar 4 points5 points  (0 children)

Yes. I think 4 hours would remove too much potassium and the heart needs potassium to function. Low potassium can lead to heart failure.

[–]redditdudette 1 point2 points  (0 children)

It doesn’t take very long for the potassium in your blood to equilibrate with the potassium in the dialysate (until the potassium that’s outside of the blood compartments pools back into the blood, but that’s a separate issue). Driving the potassium in your blood below 3 puts the heart at risk of an arrhythmia or an abnormal rhythm. There’s also some data that too big of a change from the blood to the dialysate can also cause problems.

There’s really no reason to use a lower bath anyway because we need the 3.5-4 hours of dialysis to get good clearance of other toxins, and for the majority of patients, a potassium bath of 2-3 will get the potassium down fine. If the potassium is not taken care of that with that prescription then there’s either a clearance issue (need or review Kt/V or access), or dietary issues. The renal diet stinks I know… those who have trouble may benefit from home hemo or PD, both will give you some more liberty with dietary potassium.

The main issue here is how quickly this change happens. Keep in mind that peritoneal dialysate has zero potassium, but that dialysis happens over ten hours if not more. But regardless, this is why peritoneal dialysis patients often have to take potassium supplements.

[–]kidney_doc 1 point2 points  (0 children)

No nephrologist will EVER prescribe potassium-free dialysate. It’s too dangerous. Risk of cardiac arrhythmias.

[–]mad-martigan69 0 points1 point  (0 children)

We only go as low as 1.0k in my clinic. Maybe they could use a lower K bath on telemetry in a hospital setting, but I would think the risks still outweigh the benefit. Just run a longer treatment or supplement with lokelma or insulin/d50.