Abstract: PO0923
Delivered Dialysate Potassium Is Higher Than What Is Prescribed When High Sodium and Low Bicarbonate Are Prescribed
Session Information
- Leveraging Technology and Innovation to Predict Events and Improve Dialysis Delivery
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Ali, Saiyed Wajahat, University of California Davis Department of Internal Medicine, Sacramento, California, United States
- Chin, Andrew I., University of California Davis Department of Internal Medicine, Sacramento, California, United States
Background
Most hemodialysis machines utilize the 3-stream method of making dialysate. In hospital settings, dialysate prescriptions are customized to the clinical setting. We determined the differences between delivered and prescribed dialysate K+ in unusual prescriptions.
Methods
Dialysate samples drawn 15 minutes into HD were analyzed via indirect ion-specific electrodes for Na+, K+, and HCO3-. 5200 HDs with extremes of ordered Na+ and HCO3- were analyzed. Outcome was measured versus ordered K+. Analysis used ANOVA using SPSS.
Results
Means of the difference between measured and ordered K+ and Na+ are shown in figure 1. For K+ there was significant difference amongst the groups (p<0.001). There were no differences amongst the groups for Na+.
Conclusion
When a very high Na+ is prescribed along with a low HC03- the the dialysate Na+ remains close to prescribed Na+. As the acid concentrate contains both Na+ and K+, a high Na+ and low HC03- prescription will use a relatively more of the acid concentrate and less of the bicarbonate concentrate. Dialysate prescriptions with a high Na+ and low HCO3- increased delivered dialysate K+ by an average of 0.5 mEq/L; we observed some HDs where dialysate K+ was 1 mEq/L higher than prescribed.
Ordered dialysate groups based on Na+ and HCO3-. The difference between measured and ordered potassium levels in the dialysate are shown
| Groups based on ordered dialysate Na+ and HCO3- | Measured minus ordered K+ | N |
| 1. Na >145 and HCO3 ≤25 | 0.50 ± 0.38 | 43 |
| 2. Na 135-145 and HCO3 ≤25 | 0.37 ± 0.52 | 242 |
| 3. Na ≤130 and HCO3 ≤25 | 0.08 ± 0.60 | 19 |
| 4. Na ≤130 and HCO3 ≥35 | -0.10 ± 0.35 | 11 |
| 5. Na 135-145 and HCO3 >38 | -0.08 ± 0.39 | 61 |