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Effect of Dialysate Sodium Concentration on Interdialytic Increase of Potassium

LUCA DE NICOLA^*, VINCENZO BELLIZZI, ROBERTO MINUTOLO^*, MARIO CIOFFI^*, PAOLO GIANNATTASIO^*, VINCENZO TERRACCIANO, CARMELA IODICE^*, FRANCESCO UCCELLO, BRUNO MEMOLI, BIAGIO RAFFAELE DI IORIO and GIUSEPPE CONTE^*

^* Chair of Nephrology, School of Medicine, Second University of Naples, Italy.
Chair of Nephrology, School of Medicine, University Federico II, Naples, Italy.
Chair of Nephrology, School of Medicine, Lauria Hospital, Lauria, Italy.

Correspondence to Dr. Giuseppe Conte, Via L. Caldieri, 10, 80127 Naples, Italy. Phone/Fax: +39 81 2549409; E-mail: giuseppe.conte{at}unina2.it

Abstract. To evaluate the role of plasma tonicity in the postdialysis increment of plasma potassium (p[K⁺]), the outcome of two hemodiafiltration treatments that differed only in the Na⁺ level in dialysate (Na_D)—143 mmol/L (high dialysate sodium concentration [H-Na_D]) and 138 mmol/L (low dialysate sodium concentration [L-Na_D])—were compared in the same group of uremic patients from the end of treatment (T0) to the subsequent 30 to 120 min and up to 68 h. Kt/V and intradialytic K⁺ removal were comparable. At T0, plasma [Na⁺] was 145 ± 1 and 137 ± 1 mmol/L after H-Na_D and L-Na_D, respectively (P < 0.001). The difference in plasma tonicity persisted from T0 to T68 h. At T120, p[K⁺] was increased from the T0 value of 3.7 ± 0.2 to 4.7 ± 0.2 mmol/L (P < 0.05) after H-Na_D, whereas it was unchanged after L-Na_D. The change of p[K⁺] was still different after 68 h (+76 ± 10% and +50 ± 7% in H-Na_D and L-Na_D, respectively; P < 0.05). Of note, in the first 2 h after the end of treatment, bioimpedance analysis revealed only in H-Na_D a significant 11 ± 3% decrement of phase angle that is compatible with a decrease of intracellular fluid volume at the expense of the extracellular volume. Similarly, within the same time frame, in H-Na_D, a significant reduction of mean corpuscular volume of red cells, associated with a 2 ± 1% decrease of the intracellular [K⁺], was observed. In contrast, mean corpuscular volume of red cells did not change and erythrocyte [K⁺] increased by 6 ± 1% after L-Na_D (P < 0.005 versus H-Na_D). Thus, hypertonicity significantly contributes to the increase of p[K⁺] throughout the whole interdialytic period by determining intracellular fluid volume/extracellular volume redistribution of water and K⁺.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673