Potassium Metabolism in Peritoneal Dialysis Patients

Potassium homeostasis is a critical determinant of clinical outcome in patients receiving peritoneal dialysis. In normal physiology, the balance of dietary intake, renal excretion and intracellular compartmentalisation maintains serum potassium within a narrow range. In end-stage renal disease managed by peritoneal dialysis, diminished renal clearance is partially offset by transperitoneal removal of potassium during dwell periods, but this route remains less efficient than native renal function. Hypokalaemia is a frequent complication, arising from low dietary intake, altered gastrointestinal transit, insulin therapy and inadequate dialysate potassium content. Conversely, hyperkalaemia may develop when residual renal function declines or if dialysate potassium is omitted. Both extremes predispose to arrhythmias, muscle weakness and increased mortality. Recent work has illuminated the prognostic importance of not only absolute serum potassium levels but also their temporal variability. Strategies to correct hypokalaemia include dietary counselling, dialysate modification and adjunctive pharmacotherapy. A nuanced approach that considers peritoneal membrane transport characteristics, residual renal function and patient comorbidities is essential to optimise potassium balance, improve cardiovascular stability and enhance survival in this global patient population.

Research from Nature Portfolio

Recent studies have demonstrated that the time-averaged serum potassium level and its fluctuation carry complementary prognostic information in peritoneal dialysis patients. In a two-centre retrospective cohort, a lower mean potassium concentration over the treatment period predicted significantly higher all-cause and cardiovascular mortality, whereas greater variability exacerbated this risk. Patients maintaining a time-averaged level above 4.0 mEq/L with minimal standard deviation exhibited substantially improved three-year and five-year survival rates, underscoring the disproportionate impact of both sustained hypokalaemia and its oscillations on long-term outcomes.

Potassium Metabolism in Peritoneal Dialysis Patients publication trend

The graph below shows the total number of articles in potassium metabolism in peritoneal dialysis patients across all publications each year (not limited to Nature Index journals).

Technical terms

Hypokalaemia: Serum potassium concentration below 3.5 mmol/L, associated with neuromuscular and cardiac complications.

Time-averaged serum potassium: Arithmetic mean of sequential potassium measurements over a defined period, reflecting overall electrolyte control.

Coefficient of variation: Statistical index of dispersion calculated as the ratio of the standard deviation to the mean, expressed as a percentage.

Peritoneal dialysis: Renal replacement therapy that uses the patient’s peritoneal membrane to exchange solutes and fluid with instilled dialysate.

References

1. Lower serum potassium associated with increased mortality in dialysis patients: A nationwide prospective observational cohort study in Korea. PLOS ONE (2017).
2. Low Serum Potassium Levels Increase the Infectious-Caused Mortality in Peritoneal Dialysis Patients: A Propensity-Matched Score Study. PLOS ONE (2015).
3. Time-averaged serum potassium levels and its fluctuation associate with 5-year survival of peritoneal dialysis patients: two-center based study. Scientific Reports (2015).
4. Prevalence and Management of Hypokalemia in Peritoneal Dialysis Patients in Qatar. International Journal of Nephrology (2019).