Potassium

[Panda_9]

Spot on angie 

[Panda_9]

In relation to the discussion on zero K dialysate, I received this info from my home training nurse, thought I would add it here as I asked him about using zero K dialysate.

Potassium is one of those too much and too little things. Too much and
it can kill you. Too little and it can kill you. So you have to be
like Goldie-locks. But we only have one bear.

Like most things with our bodies, they run best when within a very
small range. In the case of potassium it is between about 3.2 to 4.5
mmol/l (milimoles per litre). With renal failure, the potassium gets
too high because the kidneys are responsible for the regulation. High
potassium is very serious because it causes muscle weakness in the
lower limbs initially, irregular pulse, low blood pressure, abdominal
cramping, nausea, diarrhoea. Things get worse as the levels rise,
eventually leading to severe paralysis and cardiac arrest.

With haemodialysis the aim is to reduce the level of potassium to more
normal levels, without getting it too low. Low potassium can lead to
muscle weakness, paralysis, cramping, weak pulse, low blood pressure.
Looks very similar to high potassium. However, this is the more common
condition, except when you have renal failure.

With haemodialysis, there is an initial very rapid removal of potassium
(and other stuff) with the blood level gradually reaching a balance.
If there was no potassium in the dialysate, then the level would
continue to drop. Leading to severe hypokalaemia (low potassium). With
very long dialysis, as with nocturnal, the level would be too low for
too long. Once dialysis is stopped, the level once again starts to
rise, getting into the normal range quickly and then going beyond
again until the next dialysis.

The commercial dialysate that we use comes in K 1.0, 1.5 and 2.0. Most
people on nocturnal add some potassium to make the 1.0 a 1.5. This
seems to keep people in a more comfortable range. Because you are
getting such good dialysis and all your figures are low anyway, they
tend to stay in the more normal range for longer.

[sandman]

Thanks Amber, that is very informative.

[angieskidney]

Amber can I quote that info for my own person use?

[Panda_9]

Here is a bit more info. I must say I am learning something here! I don't see why you couldn't use it Angie  For personal reasons I have taken names and details out of the quote.

If your level went too low on nocturnal for some reason, can it still rebound and go too high?


Well, we are hoping that it will not go too low while doing the long
dialysis. That is why there is some potassium in the dialysate. To
keep things in the normal range through the night.

The rebound for someone on nocturnal tends to be less dramatic. This
is probably partly due to the body being able to get rid of excess
potassium as the acid levels become more balanced.

In renal failure, you also get an increase in acid in the blood. The
body doesn't know what to do with the excess acid because the kidneys
look after that. It does the equivalent of stuffing it in a draw. It
put as much acid (hydrogen ions) as it can into any spare cell. The
trade off is that something has to come out of the draw. That's
potassium. It leaves the cell and moves out into your blood.

However, dialysis fixes the acidosis by using bicarbonate. The long
dialysis enables all that stuff shoved in the draw to come out.
Potassium then has to go back into the cell to maintain the balance.
this is why some potassium is needed in the dialysate. Once you stop
dialysis, the acid levels begin to rise again and so does the
potassium as the body does the hydrogen/potassium swap. With nocturnal
though, it rises and falls more like a gentle ripple rather than a
storm surge as with shorter dialysis.

Even if you are very strict with potassium in your diet. There will
still be an increase in potassium due to the acid changes occurring in
your body.

[AlasdairUK]

I have found this thread really useful.  I have never had a problem with high K. In fact my K is on the low side. I have just had my K increased in dialysis as it was too low. My pre being about 4.5 and my post 2.7. I'm now on the 2K.

I remember when I first had dialysis 10 years ago my K was really high and they couldnot bring it down and my diet was more restricted than it is now.

Half the things I'm not allowed to eat or that are harmful I do not seem to like or enjoy eating. I often wonder if my body knew that it was harmful for me while I was growing up and tried to stop me eating them before my kidneys gave up.

[Zach]

Half the things I'm not allowed to eat or that are harmful I do not seem to like or enjoy eating. I often wonder if my body knew that it was harmful for me while I was growing up and tried to stop me eating them before my kidneys gave up.

Whatever the reason, it's good that you have come to that point.     

[Rerun]

I fought to stay on 2K but my potassium was too high.  Finally I realized "Hey, screw it, let them put me on 1K and then my Potassium will be good" and it is.   

[Zach]

I fought to stay on 2K but my potassium was too high.  Finally I realized "Hey, screw it, let them put me on 1K and then my Potassium will be good" and it is.   

If you need it, go for it!

[Panda_9]

Be careful on a K1 that you dont get the rebound effect. Im a shocker for it.

[Rerun]

Be careful on a K1 that you dont get the rebound effect. Im a shocker for it.

Explain~

[Panda_9]

The rebound effect is basically a result of your potassium level going too low too quickly. It is more likely to happen on conventional dialysis as the treatments are short. Here is some useful info I got of my Dx nurse....

The rebound for someone on nocturnal tends to be less dramatic. This
is probably partly due to the body being able to get rid of excess
potassium as the acid levels become more balanced.

In renal failure, you also get an increase in acid in the blood. The
body doesn't know what to do with the excess acid because the kidneys
look after that. It does the equivalent of stuffing it in a draw. It
puts as much acid (hydrogen ions) as it can into any spare cell. The
trade off is that something has to come out of the draw. That's
potassium. It leaves the cell and moves out into your blood.

However, dialysis fixes the acidosis by using bicarbonate. The long
dialysis enables all that stuff shoved in the draw to come out.
Potassium then has to go back into the cell to maintain the balance.
this is why some potassium is needed in the dialysate. Once you stop
dialysis, the acid levels begin to rise again and so does the
potassium as the body does the hydrogen/potassium swap. With nocturnal
though, it rises and falls more like a gentle ripple rather than a
storm surge as with shorter dialysis.

Even if you are very strict with potassium in your diet. There will
still be an increase in potassium due to the acid changes occuring in
your body.

From that, I understand that on conventional dialysis, you arent getting rid of all the K that is stuffed in the draw, so as a result of it dropping low after using a low K dialysate, the K from the draw is released. On nocturnal, the K is removed from the draw, therefore you wont get excess K coming out of the draw and creating a rebounding K level where it jumps up pretty quickly.

[angieskidney]

That is a VERy good post! 

[Rerun]

Yes, Amber, Thank you.   

[Panda_9]

No worries. That is the first time someone has ever explained that to me in such detail that is easy to understand. I know it doesnt apply to everyone, but it certainly does to me. Nocturnal has been a life saver for me in regards to ER trips for high K.

[mallory]

Here's a link to the USDA National Nutrient Database listing for the Potassium content in foods:

http://www.nal.usda.gov/fnic/foodcomp/Data/SR18/nutrlist/sr18a306.pdf

Hope it's helpful.

[Zach]

I thought this post by Ken Shelmerdine was important:

http://ihatedialysis.com/forum/index.php?topic=1220.msg22742#msg22742
I think it's true to say  we become experts of our own health condition. When I was pre-dialysis my potassium level went to 6.9. This level was considered to be so bad that I got a call to go to A&E immediately. They took it again at the hospital and it had come down to 6.2. which is still high. Now a few weeks previously I'd asked my renal doc if I could reduce the strength of one of my BP meds  (Beta Blockers) and maybe compensate with a higher dose of the other tablet I was taking (Candesarten, an ARB blocker) He cut the beta blocker to half strength (2.5ml) and doubled the ARB to 16ml. The day I got the call to go to A&E I had earlier in the day seen an article on the net about a clinical study that indicated ...wait for it.... raised serum potassium blood lab readings in patients using ARBs. I mentioned this to the A&E medic and after disappearing for about 10 minutes I guess to get someone else's opinion or look it up in a book,(God knows) He came back and agreed that yes this could indeed be the cause..Doh, Who's the bloody Doctor??!!!!!!!! Came off the ARB completely, replaced it with a diuretic and in 2 weeks it was down to 4.8.