Oral potassium supplementation to correct hypokalaemia lowers peritonitis risk in patients on PD

Maintaining serum potassium concentration in the range of 4–5 mEq/L with protocol-based oral potassium treatment appears to protect against peritonitis in patients who are receiving peritoneal dialysis (PD) and have hypokalaemia, according to a study.

The study included 167 adult PD patients aged ≥18 years with hypokalaemia (defined as at least three values or an average value <3.5 mEq/L in the past 6 months). They were randomized to receive either protocol-based potassium supplementation (titratable dose of oral potassium chloride to maintain serum potassium at 4–5 mEq/L; n=85) or conventional potassium supplementation (reactive supplementation when serum potassium <3.5 mEq/L; n=82) over 52 weeks.

The time-averaged serum potassium concentrations at baseline were 3.33 mEq/L. Over a median follow-up of 401 days, serum potassium levels showed a greater increase in the protocol-based than in the conventional treatment group (4.36 vs 3.57 mEq/L; mean difference, 0.66 mEq/L, 95 percent confidence interval [CI], 0.53–0.79; p<0.001).

The primary outcome of median time to first peritonitis episode was markedly longer in the protocol-based group (223 vs 133 days; p=0.03). Compared with conventional treatment, the protocol-based treatment was associated with a 53-percent lower risk of peritonitis (hazard ratio [HR], 0.47, 95 percent CI, 0.24–0.93).

There were no significant between-group differences noted in any of the secondary outcomes (all-cause mortality, cardiovascular mortality, hospitalization, and conversion to haemodialysis).

Three patients (4 percent) in the protocol-based treatment group achieved asymptomatic hyperkalaemia (>6 mEq/L) without characteristic electrocardiographic changes.