Management of hyperkalemia in critically ill renal patients undergoing peritoneal dialysis

Abstract

Hyperkalemia is defined as a plasma or serum potassium concentration above the established reference range and is frequently encountered in various pathologies. The potassium gradient between the intra- and extracellular compartments plays a key role in action potential generation by excitable cells. Serum potassium concentration in patients diagnosed with chronic kidney disease is usually balanced, but hyperkalemia may develop in patients with acute kidney injury in stage III and IV. According to recent studies, hyperkalemia is a serious complication in patients diagnosed with chronic kidney disease in IRIS stage II, III and IV. The occurrence and severity of hyperkalemia may also be aggravated by the inadequate administration of potassium in enteral or parenteral fluids, metabolic acidosis, and the use of angiotensin-converting enzyme inhibitors. Excess potassium is continuously excreted by the kidneys, and its concentrations in urine are higher than those in serum. Compromised excretion will predictably lead to both hyperkalemia and azotemia. The extent of these changes is variable and depends on the underlying etiology. Hyperkalemia can be treated by antagonizing its effects on cell membranes with calcium gluconate, or by introducing extracellular potassium into cells with sodium bicarbonate or glucose. Also, the removal of potassium from the body can be done through dialysis.