Objective: This study determined relationship between total body potassium (TBK) and morbidity and mortality of patients with end stage renal disease (ESRD). DESIGN, PATIENTS, SETTING: Long term observational study of 15 ESRD patients receiving chronic hemodialysis in an academically affiliated Veterans Affairs Medical Center Hospital. METHODOLOGY AND OUTCOME MEASURE: TBK by whole-body counting of 40K, dialysis potassium losses, and patient demographic characteristics were determined. Survival was evaluated retrospectively after seven years of follow-up.
Results: Six of 15 patients (40%) had TBK depletion. All patients who were TBK depleted, expired by study end. In contrast, only 4 of 9 patients with normal K+ stores had died during the same time period (P<0.02). Median survival time of subjects with normal TBK was 100 vs 55 months for the depleted group (chi2=4.6, P<0.05). Patients with normal TBK were younger (41.9 vs 62.5 years, P<0.02) and predominantly black (78%). The ESRD group with normal TBK received more hours of hemodialysis (HD) per week (11.2 hours vs 9.7, P<0.02) and had greater K+ removal than the depleted patients (70.5 mmol/treatment vs 43.8). Urea reduction ratio was not statistically different between groups. Serum albumin, interdialytic increases in BUN and weight, and body mass index were not different between normal and TBK depleted groups.
Conclusions: TBK depletion occurs in a significant proportion of HD patients and is associated with increased mortality. It is prudent to customize HD and dietary prescriptions to maintain normal levels of TBK in ESRD patients.