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Hypokalemia in peritoneal dialysis patients in Thailand: the pivotal role of low potassium intake

  • Nephrology - Original Paper
  • Published:
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Abstract

Objective

Hypokalemia is highly prevalent in chronic peritoneal dialysis (PD) patients worldwide, particularly in Thailand. This study aims to investigate the major determinants of hypokalemia in Thai PD patients.

Methods

A cross-sectional study was performed in chronic PD patients at 4 PD centers in Bangkok, Thailand. Hypokalemia was defined if the average serum potassium level during the last 3 consecutive visits was < 3.5 mEq/L. Patients and/or their caregivers were asked to perform a 3-day dietary food record and take pre- and post-meal pictures following the instructed protocol. Daily dietary nutrients, including potassium, were estimated by a single dietician using INMUCAL-N software. Total potassium excretion was determined by 24-h PD effluents and urine collection. Intracellular and extracellular water values (ICW and ECW, respectively) were measured by electrical bioimpedance assay (BIA) to indirectly explore the role of intracellular potassium shift in hypokalemia.

Results

Among 60 eligible PD patients, 19 (31%) had hypokalemia. Hypokalemic patients had significantly lower dietary potassium intake (24.4 ± 11.1 vs. 30.5 ± 9.4 mEq/day, p = 0.031) and lower total potassium excretion (28.5 ± 8.4 vs. 36.7 ± 11.2 mEq/day, p = 0.006) compared to normokalemic patients. Both groups had comparable values of ICW and ECW. On logistic regression, there was no significant correlation between hypokalemia and daily PD exchange volume, total Kt/Vurea, residual renal function, concurrent medications (insulin, diuretics, renin–angiotensin–aldosterone inhibitor, and beta-blockers) or ICW. Low dietary potassium was an independent risk factor for hypokalemia.

Conclusion

Low dietary potassium intake, rather than increased potassium excretion or intracellular shift, is the major contributing factor of hypokalemia in Thai chronic PD patients. Dietary intervention or potassium supplement protocol should be implemented.

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Acknowledgements

The authors would like to acknowledge the staff, nurses, and all investigators who work at the participating study facilities, including King Chulalongkorn Memorial Hospital, Bangkok Metropolitan Administration General Hospital, Taksin Hospital, and Banphaeo Hospital. We also appreciate the great contribution of the dietitian, Miss Kamonchanok Khasuwan, to educate the patients and facilitate the dietary evaluation throughout the study. This study was supported by Rachadaphiseksompot Fund, Faculty of Medicine (RA61/084), Rachadaphiseksompot Endorsement Fund, Chulalongkorn University (CU-GRS_60_12_30_05), National Research Council of Thailand (156/2560), and Thailand Research Foundation (IRG5780017).

Funding

This study was supported by Rachadaphiseksompot Fund, Faculty of Medicine (RA61/084), Rachadaphiseksompot Endorsement Fund, Chulalongkorn University (CU-GRS_60_12_30_05), National Research Council of Thailand (156/2560), and Thailand Research Foundation (IRG5780017).

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

    Mathurot Virojanawat, Pongpratch Puapatanakul, Pisut Katavetin, Kearkiat Praditpornsilpa, Somchai Eiam-Ong & Talerngsak Kanjanabuch

  2. Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Pongpratch Puapatanakul & Talerngsak Kanjanabuch

  3. Peritoneal Dialysis Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

    Pongpratch Puapatanakul & Talerngsak Kanjanabuch

  4. Banphaeo Dialysis Group (Bangkok), Banphaeo Hospital, Bangkok, Thailand

    Piyatida Chuengsaman

  5. Division of Nephrology, Department of Medicine, Taksin Hospital, Bangkok, Thailand

    Chanchana Boonyakrai

  6. Bangkok Metropolitan Administration General Hospital, Bangkok, Thailand

    Sompon Buranaosot

Authors
  1. Mathurot Virojanawat
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  2. Pongpratch Puapatanakul
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  3. Piyatida Chuengsaman
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  4. Chanchana Boonyakrai
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  6. Pisut Katavetin
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  8. Somchai Eiam-Ong
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  9. Talerngsak Kanjanabuch
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by MV and PP. The first draft of the manuscript was written by MV, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Talerngsak Kanjanabuch.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study protocol was approved by the ethics committee of King Chulalongkorn Memorial Hospital and each participating center.

Consent to participate

Each participating patient provided informed consent.

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Virojanawat, M., Puapatanakul, P., Chuengsaman, P. et al. Hypokalemia in peritoneal dialysis patients in Thailand: the pivotal role of low potassium intake. Int Urol Nephrol 53, 1463–1471 (2021). https://doi.org/10.1007/s11255-020-02773-8

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  • DOI: https://doi.org/10.1007/s11255-020-02773-8

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