Potassium for Dialysis Patients: Can It Prevent Infections?

randomized-controlled-trial PMID: 35597332

Quick Summary: A new study found that taking potassium supplements helped peritoneal dialysis patients with low potassium levels avoid a common infection called peritonitis. Patients who took potassium supplements to keep their levels in a healthy range had fewer infections than those who only took supplements when their potassium got very low.

Why Potassium Matters for Dialysis

If you're on peritoneal dialysis, your kidneys aren't working properly, and you might have low potassium levels (hypokalemia). This can lead to health problems. This study looked at whether taking potassium supplements could help.

What The Research Found

The study showed that:

Patients who took potassium supplements to keep their potassium levels in a healthy range (4-5 mEq/L) had fewer episodes of peritonitis (a serious infection) compared to those who only took supplements when their potassium levels dropped below 3.5 mEq/L.

The group taking potassium supplements to maintain healthy levels had a longer time before their first peritonitis infection.

Study Details

Who was studied: 167 adults on peritoneal dialysis with low potassium levels.

How long: The study lasted for about a year (52 weeks), with a follow-up period of about 400 days.

What they took:

Group 1: Took potassium supplements (potassium chloride) to keep their potassium levels between 4 and 5 mEq/L.
Group 2: Only took potassium supplements when their potassium levels dropped below 3.5 mEq/L.

What This Means For You

If you're on peritoneal dialysis and have low potassium, this research suggests that taking potassium supplements to keep your levels in a healthy range might help prevent peritonitis. Talk to your doctor about your potassium levels and whether you need to adjust your supplement plan.

Study Limitations

The study wasn't "blinded," meaning the doctors knew who was getting which treatment. This could have affected the results.

The study was relatively short.

A few people in the supplement group had high potassium levels, so it's important to monitor your levels.

Key Findings

Protocol-based potassium supplementation (targeting serum potassium 4-5 mEq/L) significantly reduced the risk of peritonitis compared to conventional reactive supplementation (serum potassium <3.5 mEq/L threshold). The protocol group had a median time to first peritonitis episode of 223 days vs. 133 days in the conventional group (HR 0.47, 95% CI 0.24-0.93, P = 0.03). Serum potassium levels increased by 0.66 mEq/L in the protocol group (4.36 ± 0.70 vs. 3.57 ± 0.65, P < 0.001). No significant differences were observed in all-cause mortality, cardiovascular mortality, hospitalization, or dialysis conversion. Three patients (4%) in the protocol group developed asymptomatic hyperkalemia (>6 mEq/L) without ECG changes.

Study Design

This was a multicenter, open-label, randomized controlled trial (RCT) involving 167 adult peritoneal dialysis (PD) patients with chronic hypokalemia (≥3 measurements or average <3.5 mEq/L over 6 months). Participants were stratified by PD center and residual urine output (≤100 or >100 mL/day). The 52-week trial used intention-to-treat analysis with Cox proportional hazards regression. Follow-up median was 401 days (IQR 315-417).

Dosage & Administration

Protocol-based treatment involved titratable oral potassium chloride doses adjusted to maintain serum potassium within 4-5 mEq/L. Conventional treatment administered potassium only when serum levels fell below 3.5 mEq/L. Specific dosing ranges were not detailed in the summary, but adjustments were made prospectively based on serial potassium monitoring in both groups.

Results & Efficacy

Primary Outcome: Time to first peritonitis episode was significantly prolonged in the protocol group (median 223 vs. 133 days; P = 0.03; HR 0.47).
Serum Potassium: Protocol group achieved target levels (4.36 ± 0.70 mEq/L) vs. conventional group (3.57 ± 0.65; mean difference 0.66, 95% CI 0.53-0.79; P < 0.001).
Secondary Outcomes: No significant differences in mortality (all-cause or cardiovascular), hospitalization rates, or dialysis conversion (P > 0.05 for all).
Safety: 4% of protocol group patients developed asymptomatic hyperkalemia, though without clinical complications.

Limitations

Open-label design: Lack of blinding may introduce performance bias.
Single-center monitoring: Outcomes were assessed by unmasked investigators, potentially affecting event reporting.
Moderate sample size: 167 participants may limit power for secondary outcomes (e.g., mortality).
Short duration: 52 weeks may insufficient to detect long-term risks or benefits.
Asymptomatic hyperkalemia: Safety profile requires further investigation in larger cohorts.

Clinical Relevance

For hypokalemic PD patients, proactive potassium supplementation to maintain serum levels of 4-5 mEq/L may reduce peritonitis risk—a critical complication in this population. However, the lack of mortality benefit and potential for hyperkalemia necessitate cautious dose titration and close monitoring. Clinicians should weigh the benefits of protocol-driven supplementation against the need for individualized management, particularly in patients with low residual urine output. Future double-blind trials with longer follow-up are needed to confirm these findings and assess broader clinical impacts.

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