Potassium

[Panda_9]

Are you sure its a 0 K? I think there would need to be some level of potassium in the dialysate or we'd end up dead or with a big rebound. The lowest we have here is a 1 K.

[BigSky]

Lowest here I beleive is a 1 also.  I was on a 3 until about a year ago when they put me on a 2 because of some medication I am on. 

I told them I would be willing to have no potassium added and would eat my way to the desired level.   However they didnt go for it.

[Panda_9]

If there is no potassium in the dialysate then you would think your blood level would have to be daaaaamn high to warrant using a K0, and then if it was so high you probly would be dead before you even get to dialysis. I have had levels from 6.2-6.8 and after having all the IV and oral treatment, I was then dialysed on a K1. I just cant imagine anyone dialysing on a K0.

[Zach]

Lowest here I believe is a 1 also.  I was on a 3 until about a year ago when they put me on a 2 because of some medication I am on. 

I told them I would be willing to have no potassium added and would eat my way to the desired level.   However they didn't go for it.

Would that be interesting .. a banana a day to keep the nephrologist away.   

But really, there is such bath as 0 K.  It may be used only during the last hour or so of treatment.

[Epoman]

Lowest here I believe is a 1 also.  I was on a 3 until about a year ago when they put me on a 2 because of some medication I am on. 

I told them I would be willing to have no potassium added and would eat my way to the desired level.   However they didn't go for it.

Would that be interesting .. a banana a day to keep the nephrologist away.   

But really, there is such bath as 0 K.  It may be used only during the last hour or so of treatment.

Yeah 0 K does exist, but many nephs don't like to use ZERO K, it can be dangerous. I was on ZERO K for a while, the whole 3 hours treatment. But when I went to Davita they would NOT allow it.

[Panda_9]

I wouldnt want to use a 0 K either. Hell noooooooo. I dont even like using a 1K, but its only usually when I go to high dependancy so I dont mind as much. Im on a 1.25K for nocturnal which seems to be ok so far.

[Zach]

Well, I would imagine, some patients do need it.

[Panda_9]

I just thought it was a bit extreme. Perhaps those patients dont follow the diet at all?

[BigSky]

I just thought it was a bit extreme. Perhaps those patients dont follow the diet at all?

Some patients do not.  There was a gal here who would drink orange juice and her heart would start racing.  She would still do it despite knowing that it was the potassium in it that was causing the problem.

[Zach]

It may have to do with the individual's diet, based on their culture or ethnicity.

[Panda_9]

Good point Zach. Ive seen a few Dx patients from other backgrounds and they have a very hard time trying to understand the diet. Once I heard a dietition trying to talk to this family about how their traditional diet was extremely bad for Mrs X, and they just did not get it. The whole time she was in hospital (across from me), they bought her in foods like a massive jug of soup, shellfish, all bad things. The poor dietition was ready to give up on them I think. Theres another lady, I think shes indian, who doesnt understand that rice is considered fluid as well, but she continues to eat alot of it. She often ends up with pulmonary oedema requiring admission.
Whereas me, I just cant get my head around the fluid restriction at all!

[hemohortensia]

If there is no potassium in the dialysate then you would think your blood level would have to be daaaaamn high to warrant using a K0, and then if it was so high you probly would be dead before you even get to dialysis. I have had levels from 6.2-6.8 and after having all the IV and oral treatment, I was then dialysed on a K1. I just cant imagine anyone dialysing on a K0.

I dialysed on zero K for over a decade. I wanted a more liberal diet. I kept my K at normal levels because I counted my potassium mg. intake.
Don't forget - a zero K bath doesn't necessarily drop your K to zero - it just ALLOWS it to get to zero. My pre-K levels were high normal and
post-K low normal. Now I am fine with 2K.

There was a practise in my unit to do half the treatment with zero - usually the first half and then changing to 2K. I predicted (correctly) that
it wouldn't last since it was an added task for the staff. There's an idea for Fresenius! A machine that automatically changes the dialysate! If it
doesn't exist, it should.

[Panda_9]

What? You cant let your K go to zero, if Im correct you would probably have a heart attack and die. I think it is more risky using a low K dialysate, as theres the risk of the potassium rebounding into dangerous levels, and if that happens you also can have a heart attack. Hmm I might ask around about this one, as Im not real sure about it.

[hemohortensia]

What? You cant let your K go to zero, if Im correct you would probably have a heart attack and die. I think it is more risky using a low K dialysate, as theres the risk of the potassium rebounding into dangerous levels, and if that happens you also can have a heart attack. Hmm I might ask around about this one, as Im not real sure about it.

I don't know if this post is directed to me. What your post K is depends on several factors including what your pre K was and how much dialysis you are receiving. So dialysing on a zero K bath does not necessarily bring your potassium down to zero. I kept my potassium in a normal range but slightly wider than on 2K for over 10 years. I also kept a running log of my potassium intake.

And while it is riskier than 2k, for non-compliant patients, it can be the lesser of two evils.

I do agree though that 1k is a better idea. For some reason, it wasn't an option in my unit back then.

[Epoman]

What? You cant let your K go to zero, if Im correct you would probably have a heart attack and die. I think it is more risky using a low K dialysate, as theres the risk of the potassium rebounding into dangerous levels, and if that happens you also can have a heart attack. Hmm I might ask around about this one, as Im not real sure about it.

LOL, using a ZERO K bath does not mean your potassium goes to ZERO at the end. If you potassium went to ZERO you are correct you would DIE. Using a Zero K bath means you will not receive any NEW potassium while dialyizing.

[Zach]

Good point Epoman!

[sandman]

What is the differences with the dialysate bath levels 2K, 1K and zero K?  
What do those figures stand for?
What was added to them to give these added values?

[angieskidney]

What is the differences with the dialysate bath levels 2K, 1K and zero K?  
What do those figures stand for?
What was added to them to give these added values?

K = means Potassium .. but I am still new at Hemo so I don't know how to explain the rest. Hopefully someone can explain it in simple terms.  But from what I understand from Epoman is that 0 K bath just gives none back so I assume that means that the 1K and the 2K give back a certain amount (a percentage??). I am not sure. But I DO know that you don't want your potassium to drop too low just like you don't want it to be too high. But that dialysis patients usually have higher potassium levels because they don't have kidneys to eliminate the potassium.

[BigSky]

Difference between the baths are the level concentration of potassium in them.

THe number is mEq/l--Milliequivalents per liter (K) is potassium.

In round about terms.  In dialysis the patient's blood  starts out with a higher potassium level.  So during dialysis the potassium moves from the higher concentration of the patients blood to the lower concentration of the potassium bath.

[Panda_9]

What? You cant let your K go to zero, if Im correct you would probably have a heart attack and die. I think it is more risky using a low K dialysate, as theres the risk of the potassium rebounding into dangerous levels, and if that happens you also can have a heart attack. Hmm I might ask around about this one, as Im not real sure about it.

LOL, using a ZERO K bath does not mean your potassium goes to ZERO at the end. If you potassium went to ZERO you are correct you would DIE. Using a Zero K bath means you will not receive any NEW potassium while dialyizing.

I wasnt saying that, Im not that stupid. I was repeating what  hemohortensia previously said "it just ALLOWS it to get to zero"

sandmansa, the different levels of potassium in dialysate determine how much potassium needs to be taken out of the blood until there is a safe balance in the level. If you have a high blood potassium, then you want to use a low K dialysate (Eg a K1). If you have a potassium that is in the high range of normal or thereabouts, then you would probably use a K2. Me personally, I use a K1.5 if Im dialysing in centre. In basic terms, the lower the K in the dialysate, the more K it will pull out of your blood.

[sandman]

Thanks everyone.  That was very helpful.  Now, just one last question.

What are the amounts of potassium in each level of dialysate.  Meaning exactly how much potassium is in K2, K1.5, K1 and K zero solutions?

[Panda_9]

Its not really necessary to know how much is in each but for example a K1 has 2.6g/L of potassium chloride. That is whats on mine anyway, Im assuming its the same everywhere.

[sandman]

Thanks Amber.  Please forgive the seemingly silly questions but I'm just being curious.

[Panda_9]

Thats ok, I know it must be hard not knowing things, and its only normal that you may ask some silly questions. Nothing wrong with that at all!

[angieskidney]

Difference between the baths are the level concentration of potassium in them.

The number is mEq/l--Milliequivalents per liter (K) is potassium.

In round about terms.  In dialysis the patient's blood  starts out with a higher potassium level.  So during dialysis the potassium moves from the higher concentration of the patients blood to the lower concentration of the potassium bath.

Ah that makes so much sense! So basically it works on the methods of osmosis and diffusion? (I am not sure which is which but I learned that is the method Peritoneal Dialysis works and I assume parts of Hemo dialysis too (I am still learning .. it is hard for Sandman to know when even I don't know certain things )