Clinical utility of potassium-sparing diuretics to maintain normal serum potassium in peritoneal dialysis patients

Tibor Fülöp, Lajos Zsom, Betzaida Rodríguez, Sabahat Afshan, Jamie V. Davidson, Tibor Szarvas, Mehul P. Dixit, Mihály B. Tapolyai, L. Rosivall

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6 Citations (Scopus)

Abstract

♦ Background: Hypokalemia is a vexing problem in end-stage renal disease patients on peritoneal dialysis (PD), and oral potassium supplements (OPS) have limited palatability. Potassium-sparing diuretics (KSD) (spironolactone, amiloride) may be effective in these patients. ♦ Methods: We performed a cross-sectional review of 75 current or past (vintage > 6 months) PD patients with regard to serum potassium (K+), OPS, and KSD utilization. We reviewed charts for multiple clinical and laboratory variables, including dialysis adequacy, residual renal function, nutritional status and co-existing medical therapy. ♦ Results: The cohort was middle-aged with a mean age of 49.2 years (standard deviation [SD] = 14.7) and overweight with a body mass index of 29.5 (6.7) kg/m2. Of all the participants, 57.3% were female, 73.3% African-American, and 48% diabetic with an overall PD vintage of 28.2 (24.3) months at the time of enrollment. Weekly Kt/V was 2.12 (0.43), creatinine clearance was 73.5 (33.6) L/week/1.73 m2 with total daily exchange volume of 10.8 (2.7) L. Residual urine output (RUO) measured at 440 (494) mL (anuric 30.6%). Three-month averaged serum K+ measured at 4 (0.5) mmol/L with 36% of the participants receiving K+ supplements (median: 20 [0;20] mmol/day) and 41.3% KSD (spironolactone dose: 25 – 200 mg/day; amiloride dose: 5 – 10 mg/ day). Serum K+ correlated positively with weekly Kt/V (r = 0.239; p = 0.039), PD vintage (r = 0.272; p = 0.018) but not with PD modality, daily exchange volume, RUO, or KSD use. However, KSD use was associated with decreased use of OPS (r = -0.646; p < 0.0001). ♦ Conclusions: Potassium-sparing diuretics were effective in this cohort of PD patients and decreased the need for OPS utilization.

Original languageEnglish
Pages (from-to)63-69
Number of pages7
JournalPeritoneal Dialysis International
Volume37
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

Keywords

  • Amiloride
  • End-stage renal disease
  • Hypokalemia
  • Peritoneal dialysis
  • Potassium supplements
  • Residual renal function
  • Spironolactone

ASJC Scopus subject areas

  • Nephrology

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    Fülöp, T., Zsom, L., Rodríguez, B., Afshan, S., Davidson, J. V., Szarvas, T., Dixit, M. P., Tapolyai, M. B., & Rosivall, L. (2017). Clinical utility of potassium-sparing diuretics to maintain normal serum potassium in peritoneal dialysis patients. Peritoneal Dialysis International, 37(1), 63-69. https://doi.org/10.3747/pdi.2016.00022