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