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ARS Home » Plains Area » Houston, Texas » Children's Nutrition Research Center » Research » Publications at this Location » Publication #67673
Title: ACUTE DECREASES IN SERUM POTASSIUM AUGMENT BLOOD PRESSSURE

Author
item DOLSON, GEORGE - BAYLOR COLL OF MEDICINE
item Ellis, Kenneth
item BERNARDO, MARIALIZA - BAYLOR COLL OF MEDICINE
item PRAKASH, RAHUL - BAYLOR COLL OF MEDICINE
item ADROGUE, HORACIO - BAYLOR COLL OF MEDICINE

Submitted to: American Journal of Kidney Diseases
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/28/1995
Publication Date: N/A
Citation: N/A

Interpretive Summary: Potassium depletion is a risk factor for cardiovascular diseases. In patients with kidney failure, the dialysis process may contribute to excess loss of potassium and hence increased blood pressure. In this study, the regular dialysate solution was altered to extract below normal and excess amounts of potassium from the body. In the case when too much potassium was removed the patients exhibited increased blood pressure, whereas lowering the amount of potassium removed maintained a lower blood pressure. The results of this study have implications beyond that of alterations in blood pressure. Rapid removal of potassium during dialysis might, over time, lead to vascular resistance that contributes to the increased incidence of myocardial and brain ischemia in these patients, even after kidney transplant.

Technical Abstract: Potassium depletion is a risk factor for cardiovascular diseases including hypertension, and is frequently encountered in patients with end stage renal disease (ESRD). Since the treatment of ESRD might result in K+ depletion and post-dialysis hypokalemia, we investigated the relationship between acute K+ removal by hemodialysis and changes in blood pressure (BP) )at the completion of treatment compared to pre-dialysis and one-hour post-dialysis BP. The effects of three different dialysate potassium concentrations ((K+)d), 1.0, 2.0, and 3.0 mmol/L, were investigated in 11 patients. Hemodialysis-induced K+ removal, serum (K+), total body K+ (TBK), and BP, were measured. The use of 1.0, 2.0, or 3.0 mmol/L (K+)d resulted in the removal of 77.0 6.5, 54.5 7.9, and 42.5 9.9 mmol of K+ per treatment, respectively (P<0.05 (K+)d 1.0 versus (K+)d 3.0). Pre and post-dialysis serum (K+) were 4.9 0.2 and 3.6 0.1 meq/l for 1.0 mmol/L (K+)d; 5.1 0.3 and 3.9 0.1 meq/l for 2.0 mmol/L (K+)d; 5.3 0.3 and 4.2 0.2 meq/l for 3.0 mmol/L (K+)d (P<0.001 for each (K+)d ). The baseline TBK corrected for gender, age, and race, was 92% of predicted normal level and did not change significantly with the use of different (K+)d. Blood pressure decreased during hemodialysis as excess fluid was removed regardless of (K+)d. Significant increases in BP did occur one- hour post-dialysis as compared to levels measured at the completion of treatment ("rebound hypertension") when hemodialysis was performed with 1.0 and 2.0 mmol/L, but not with 3.0 mmol/L (K+)d. Mean BP expressed in mm Hg, increased from 93.4 4.6 (1.0 mmol/L (K+)d) and 92.3 3.1 (2.0 mmol/L (K+)d) to 106.9 5.7 (P<0.05) and 102.1 4.6 (P<0.05), respectively.