Kidney Week

Abstract: SA-PO556

Can Oral Potassium Binders Be Added to Dialysate to Improve the Efficacy of Hemodialysis?

Session Information

• Hemodialysis: Biomarkers, Translational Research
  November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Tehrani, Rouzbeh, Temple University, Philadelphia, Pennsylvania, United States

Rouzbeh Tehrani,

• Gillespie, Avrum, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States

Avrum Gillespie,

• Alderfer, Juliana, Temple University, Philadelphia, Pennsylvania, United States

Juliana Alderfer,

Background

Can commercially available oral potassium (K+) binders (sodium zirconium cyclosilicate, ZS-9) be added to the dialysate to improve diffuse clearance and reduce dialysate usage while decreasing blood-dialysate K+ gradients?

Methods

This is an in-vitro hemodialysis experiment using 1 liter of freshly collected Li-heparinized porcine blood dialyzed with an average blood flow rate of 30 mL/min and dialysate flow of 50 mL/min, two peristaltic pumps, Fresenius Optiflux hemodialysis membranes, and CitraPure dialysate concentrate (Rockwell Medical). For the potassium management experiment, 5 g of ZS-9 was added to 1 L of dialysate. Dialysate K+ was set to 4 mmol/L for the management of the potassium concentration gradient (delta C_K). ZS-9 leaching to blood was tested by examining blood specimens after 5-hour hemodialysis, using highly concentrated Nano-Slurry (10 to 20 g/l) dialysate and increased transmembrane pressure (reversed), and measuring the reverse filtrate for nanoparticles for turbidity and nanoparticle materials using inductively coupled plasma mass spectrometry.

Results

In experiment 1, blood K+ was 5 mmol/L and dialysate K+ was 4 mmol/L plus ZS-9 ( delta C_K=1), by 60 minutes using recirculated dialysate, serum K+ had decreased to 3.5 mmol/L and dialysate K+ 3.0 mmol/L. In experiment 2, the blood K+ was 8 mmol/L and the dialysate 4 mmol/L plus ZS-9 (delta C_K=4), by 60 minutes using recirculated dialysate, the serum potassium was 4 mmol/L. In experiment 3, the starting serum potassium was 8 and the bath was 4 K+, after the addition of ZS-9, potassium dropped to 5.8 at 20 minutes, and then after the addition of ZS-9 at 40 minutes, potassium dropped to 2.5mmol/L and maintained at equilibrium. The addition of ZS-9 in increments was to manage C_K gradient throughout the treatment. No suspended particles and no trace amount of Zr or Si were detected passing through the membrane from dialysate to blood.

Conclusion

The addition of commercially available K+ binder, sodium zirconium cyclosilicate (ZS-9), effectively lowered potassium using recirculated dialysate while maintaining a minimal concentration gradient throughout the treatment. The addition of K+ binders to dialysate can be incorporated into a novel hemodialysis machine that can recirculate dialysate and offer the management of K+ throughout the treatment.