Kidney Week

Abstract: PUB122

Trajectory of Hyperkalemia During Urgent Initiation of Peritoneal Dialysis or Hemodialysis in Patients with ESKD

Session Information

• Publication Only

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Chavez, Jonathan, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Jonathan Chavez, PhD

• Garcia-Garcia, Guillermo, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Guillermo Garcia-Garcia, MD, FASN

• Medina, Ramon, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Ramon Medina, MD

• Navarro Blackaller, Guillermo, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Guillermo Navarro Blackaller, MD

• Alcantar Vallin, Maria de la Luz, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Maria de la Luz Alcantar Vallin, MD

• Martínez Gallardo González, Alejandro, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Alejandro Martínez Gallardo González

• Mendoza Gaitán, Héctor Eduardo, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Héctor Eduardo Mendoza Gaitán, MD

• Gómez Fregoso, Juan, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Juan Gómez Fregoso, MD

Background

Hemodialysis (HD) and peritoneal dialysis (PD) appropriately reduces potassium (K⁺). We perceive that the nephrology community considers HD, is more efficient than PD for HyperK in incident patients who starting KRT for ESKD; however, the evidence supporting this perception is scarce.

Methods

A prospective cohort of incident ESKD patients in urgent initiation of KRT and severe HyperK (K⁺ >6.5 mEq/L), we compare the trajectory of K⁺ during hospitalization treated with HD or PD, as well as its evolution. The primary outcome was the trajectory of HyperK between the PD and HD groups. The secondary outcomes were the daily trajectory of K⁺, mortality, catheter dysfunction, and the current modality at the end of follow-up.

Results

Characteristics did not differ between DP and HD groups (p > 0.05). Mean age 50 years, K⁺ 6.99 mEq/L (6.7-7.6), sCr 15.9 mg/dL (11.5-23.1), whit an eGFR of 2.91 ml. PD had an average of 25 exchanges and the HD group had 2.58 sessions during hospitalization. K⁺ levels decreased similarly in both groups (p = >0.05). PD and HD group started with K⁺ 6.8 and 7.0 mEq/L respectevely, p = 0.28. K⁺ reduced from the first day in both modalities (PD 6.03 and HD 5.90 mEq/L ), and continue to reduce until the 5th day, where both groups reach normokalemia. The probability of having HyperK decreased to 25% from day 4 in btoh groups (Log-rank 0.78).

Conclusion

In this prospective cohort of patients with ESKD and hyperK who urgently start PD, HD, K⁺ reduction was achieved similarly between modalities. Reductions in K⁺ were observed starting on the first day of treatment, reaching normokalemia by day 4 and plateauing at safe levels

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025gzz4gdsj