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Abstract: PO0923

Delivered Dialysate Potassium Is Higher Than What Is Prescribed When High Sodium and Low Bicarbonate Are Prescribed

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ali, Saiyed Wajahat, University of California Davis Department of Internal Medicine, Sacramento, California, United States
  • Chin, Andrew I., University of California Davis Department of Internal Medicine, Sacramento, California, United States
Background

Most hemodialysis machines utilize the 3-stream method of making dialysate. In hospital settings, dialysate prescriptions are customized to the clinical setting. We determined the differences between delivered and prescribed dialysate K+ in unusual prescriptions.

Methods

Dialysate samples drawn 15 minutes into HD were analyzed via indirect ion-specific electrodes for Na+, K+, and HCO3-. 5200 HDs with extremes of ordered Na+ and HCO3- were analyzed. Outcome was measured versus ordered K+. Analysis used ANOVA using SPSS.

Results

Means of the difference between measured and ordered K+ and Na+ are shown in figure 1. For K+ there was significant difference amongst the groups (p<0.001). There were no differences amongst the groups for Na+.

Conclusion

When a very high Na+ is prescribed along with a low HC03- the the dialysate Na+ remains close to prescribed Na+. As the acid concentrate contains both Na+ and K+, a high Na+ and low HC03- prescription will use a relatively more of the acid concentrate and less of the bicarbonate concentrate. Dialysate prescriptions with a high Na+ and low HCO3- increased delivered dialysate K+ by an average of 0.5 mEq/L; we observed some HDs where dialysate K+ was 1 mEq/L higher than prescribed.

Ordered dialysate groups based on Na+ and HCO3-. The difference between measured and ordered potassium levels in the dialysate are shown
Groups based on ordered dialysate Na+ and HCO3-Measured minus ordered K+N
1. Na >145 and HCO3 ≤250.50 ± 0.3843
2. Na 135-145 and HCO3 ≤250.37 ± 0.52242
3. Na ≤130 and HCO3 ≤250.08 ± 0.6019
4. Na ≤130 and HCO3 ≥35-0.10 ± 0.3511
5. Na 135-145 and HCO3 >38-0.08 ± 0.3961