Clinical Analysis And Mechanism Of Hypokalemia In Patients With Continuous Ambulatory Peritoneal Dialysis

[Objective] To investigate the occurrence, relevant factors and mechanism ofhypokalemia on96patients treated with Continous Ambulatory Peritoneal Dialysisfollowed up by the Shenzhen Second People’s Hospital.[Methods] We analyzed96patients with ESRD regularly followed up in the peritoneal dialysis center of theShenzhen Second People’s Hospital from March2011to March2012, all the patientsunderwent peritoneal dialysis regularly for at least one month or more. We take thepatients’ last follow-up clinical data and blood biochemical examination results for dataanalysis. We compare patients’anthropometric parameters，laboratory examinations andthe general clinical conditions including the primary disease, peritoneal dialysis time,solute clearance, dialysis adequacy (ultrafiltration volume, Kt/V and Ccr), residual renalfunction (residual urine volume, residual glomerular filtration rate), themicro-inflammatory state, anemia, peritonitis, cardiovascular and cerebrovascularcomplications. Statistical Methods of t-test of two samples, counting material of thechi-square test, linear correlation (Pearson correlation coefficient), Multiple linearregression analysis (Multiple linear regression) were adopted to explore the relatedfactors of hypokalemia on CAPD patients. In order to figure out the mechanism ofhypokalemia, we measured20patients’ potassium intake (dietary and supplementalpotassium) and potassium excretion (dialysis and urine), blood samples were also drawnon the same day. Dietary potassium is evaluated by nutritionists through2days’ diet diary.[Results] A total of103patients met the inclusion criteria. Except the seven cases ofpatients with hyperkalemia, a total of96patients were involoved in this study, including20patients in hypokalemia group (20.83%),76patients of normal serum potassium(79.17%). It is found in single factor analysis that patients in low potassium group hasrelatively low serum albumin, blood urea nitrogen, serum creatinine, standardizationprotein nitrogen present rate, natrium，residual urine volume and residual renal function.Neutrophils, c-reactive protein, carbon dioxide binding force (CO2CP), total urea clearindex, standardization creatinine clearance, daily ultrafiltration volume, peritonealtransport characteristics of hypokalemic group are significantly higher than that of normal hypokalemic group. Meanwhile,We can see the incidence of hypokalemia washigher in diabetic nephropathy patients,hypokalemia group has high incidence ofperitonitis and cardiovascular disease. No statistically differences were seen in the twogroups of age, gender, height, weight, and body mass index, body surface area，dialysisduration, anemia, calcium and phosphorus metabolism, ferritin, total protein, globulin,cholesterol, triglycerides, uric acid, drug use, the use of peritoneal dialysis fluid, totaldaily exchange volume, Total urea clearance, standardization of creatinine clearance,Peritoneal urea clearance index，Peritoneal creatinine clearance. Relevant analysis ofPearson showed that the serum potassium is proportional to serum albumin (r=0.578, p=0.000), blood urea nitrogen (r=0.289, p=0.004), serum creatinine (r=0.391, p=0.002), serum sodium (r=0.290, p=0.004). Serum potassium level is inverselyproportional to fasting plasma glucose (r=-0.427,p=0.000), C-reactive protein (r=-0.320,p=0.020). Multiple linear regression showed that low serum albumin, highfasting blood glucose is an independent risk factor for hypokalemia occurrance. When weexplore the pathogenesis of hypokalemia among the CAPD patients,we found that for20patients with hypokalemia, potassium intake minus the excretion of potassium can notexplain the trend of hypokalemia on CAPD patients, thus speculated that potassiumhomeostasis disorder is the main reason leading to hypokalemia on CAPD patients.[Conclusion] The incidence of hypokalemia on CAPD patients in our peritonealdialysiscenter is20.83%;The incidence of hypokalemia was higher in diabetic nephropathypatients,the incidence of peritonitis and Cardiovascular and cerebrovascularcomplications rate are relatively higher in hypokalemic group. Hypokalemia group havepoor nutrition and high micro-inflammatory condition.Low serum albumin and highfasting blood glucose are independent risk factors for hypokalemia on CAPD patients.Potassium homeostasis disorder may be the main reason leading to hypokalemia onCAPD patients.