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Abstract: TH-PO299

Dietary Potassium Intake and Hypokalemia in Peritoneal Dialysis Patients in Thailand

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Virojanawat, Mathurot, Chulalongkorn University, Bangkok, Thailand
  • Puapatanakul, Pongpratch, Chulalongkorn University, Bangkok, Thailand
  • Boonyakrai, Chanchana, Taksin hospital, Bangkok, Thailand
  • Chuengsaman, Piyatida, Banphaeo Hospital, Bangkok, Thailand
  • Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand
  • Tungsanga, Kriang, Chulalongkorn University, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand
  • Kanjanabuch, Talerngsak, Chulalongkorn University, Bangkok, Thailand
Background

Poor dietary intake might account for the high prevalence of hypokalemia in peritoneal dialysis (PD) patients in Thailand but the clinical evidence is still lacking.

Methods

A cross-sectional study was performed in stable prevalent PD patients at 4 PD centers in Thailand. Hypokalemia was defined if the average serum potassium level during the last 3 consecutive visits was <3.5 mEq/L, while the patients were considered normokalemic if the average serum potassium was 3.5 to 5.5 mEq/L. Patients were asked to perform 3-day dietary food record and take pre- and post-meal pictures of all foods they had taken following the provided instruction. Daily dietary nutrients including dietary potassium of all eligible patients were then estimated by a dietician using INMUCAL-N software. Total potassium excretion was determined by 24-hour PD effluents and urine collection. Intra- and extra-cellular water status were also assessed by electrical bioimpedance assay to explore the role of intracellular potassium shift and serum potassium status.

Results

Among 60 consecutive eligible PD patients, 19 (31.0%) had hypokalemia. Mean dietary potassium and total calories intake were 28.6±10.3 mEq/day and 1,088.0±335.4 Kcal/day, respectively. Dietary potassium intake was significantly lower in hypokalemic patients compared to normokalemic patients (24.4±11.1 vs. 30.5±9.4 mEq/day, p=0.031). Surprisingly, total potassium excretion was significantly lower in patients with hypokalemia (28.5±8.4 vs. 36.7±11.2 mEq/day, p=0.006). There was no significant correlation between serum potassium and daily PD exchange volume, total Kt/Vurea, urine volume, residual glomerular filtration rate, concurrent medications (insulin, ACEI/ARB, beta blocker, and spironolactone) or intracellular water (ICW). Low dietary potassium was an independent risk factor for hypokalemia after adjustment for insulin therapy, diuretic use, and peritoneal membrane transport. The risk of hypokalemia decreased by 15% for every 10 mEq increase in daily potassium intake.

Conclusion

Low dietary potassium intake, rather than increased potassium excretion or intracellular shift, is the major contributing factor to hypokalemia in Thai PD patients. Dietary intervention or potassium supplement protocol should be implemented.

Funding

  • Private Foundation Support