Evidence for a causal relationship between hyperkalaemia and axonal dysfunction in end-stage kidney disease

Clin Neurophysiol. 2014 Jan;125(1):179-85. doi: 10.1016/j.clinph.2013.06.022. Epub 2013 Jul 16.


Objective: Potassium (K(+)) has been implicated as a factor in the development of uraemic neuropathy. This study was undertaken to investigate whether hyperkalaemia plays a causal role in axonal dysfunction in end-stage kidney disease (ESKD).

Methods: Median motor nerve excitability studies were undertaken in four haemodialysis patients during a modified dialysis session. The serum K(+) level was "clamped" (fixed) for the first 3h of dialysis, whilst allowing all other solutes to be removed, this was followed by dialysis against low dialysate K(+) for a further 4 h. Blood chemistry and nerve excitability studies were undertaken prior to, during and following dialysis. Results were compared to results from the same patients during routine dialysis sessions.

Results: All patients demonstrated significant nerve excitability abnormalities reflective of nerve membrane depolarization in pre-dialysis recordings (p<0.01). After the 3 h clamp period, serum K(+) remained elevated (5.0 mmol/L) and nerve excitability remained highly abnormal, despite the significant clearance of other uraemic toxins. In contrast, studies undertaken during routine dialysis sessions demonstrated significant improvement in both serum K(+) and nerve function after 3 h.

Conclusions: The current study has established a causal relationship between serum K(+) and axonal membrane depolarization in haemodialysis patients.

Significance: From a clinical perspective, strict K(+) control may help improve nerve function in ESKD.

Keywords: Dialysis; Membrane potential; Nerve excitability; Potassium; Uraemic neuropathy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Axons / physiology*
  • Female
  • Humans
  • Hyperkalemia / complications
  • Hyperkalemia / physiopathology*
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / physiopathology*
  • Male
  • Median Nerve / physiopathology
  • Peripheral Nervous System Diseases / etiology
  • Peripheral Nervous System Diseases / physiopathology*
  • Potassium / blood
  • Renal Dialysis / adverse effects
  • Uremia / complications


  • Potassium