Renal Insufficiency Still Eating Red Bayberry? Man Admitted To Hospital For Hemodialysis With Soaring Blood Potassium

A few days ago, a man in Wenling suddenly felt weak and could not lift his legs. When he went to the hospital for examination, he found that his blood potassium was 7.24mmol/L and his creatinine was 708μmol/L. The man was in critical condition, and the nephrologist rushed to give him hemodialysis and other treatments, and his condition gradually improved.

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Red bayberry is a fruit with high potassium content. The potassium content in 100g bayberry is as high as 149mg. But is Bayberry the culprit?

Excessive intake of potassium-containing foods generally does not lead to hyperkalemia, but it can occur in patients with renal insufficiency, especially in anuric patients with renal failure. In the follow-up inquiry, it was learned that the man had a history of diabetes and poor renal function, which was the key to the man's severe hyperkalemia.

Patients with kidney disease are more prone to hyperkalemia and should reduce their intake of potassium-rich foods

Chronic kidney disease (CKD) refers to chronic kidney structure and dysfunction caused by various reasons for ≥3 months. Common causes include chronic nephritis, diabetes, and hypertension. Similar to the above-mentioned man who overeats bayberry, CKD patients may have no special symptoms in the early stage and may develop heart failure, gastrointestinal bleeding, mental abnormalities, muscle weakness, sensory nerve disorders, etc. in severe cases. Life is in danger.

Hyperkalemia is not uncommon in CKD. The kidneys of healthy people can effectively load the dietary potassium in the urine, but the increase of serum potassium is very common in CKD patients due to abnormal renal function. Hyperkalemia increases the risk of arrhythmia and sudden death, and its prevalence increases in the advanced stage of CKD, and it is associated with poor prognosis. Therefore, controlling elevated potassium is essential to reduce mortality in the CKD patient population[1-2].

In terms of diet, the overall strategy is to reduce the intake of potassium-rich foods to reduce serum potassium, but too low dietary potassium intake is not conducive to the health of patients. Potassium exists in many foods such as fruits, vegetables, meat, grains, and dairy products, and is one of the important sources of human fiber and vitamins. Therefore, under the premise of ensuring a certain dietary potassium intake, limiting excessive potassium intake is the key that patients with kidney disease need to be familiar with[1,3].

How is hyperkalemia treated in patients with CKD?

The treatment of hyperkalemia in CKD is divided into acute treatment and chronic control of serum potassium.

acute treatment

In the case of the acute elevation of blood potassium in this case, the key to treatment is to antagonize the effect of ions on the cell membrane and increase the intake of intracellular potassium to reduce serum potassium in a short time.

Treatment options are calcium gluconate, insulin, sodium bicarbonate, beta-adrenergic antagonists, diuretics, and/or initiation or intensification of dialysis.

chronic control

Chronic control of serum potassium in CKD is a more long-term management issue. For CKD patients complicated with hyperkalemia, drugs related to elevated serum potassium levels should be adjusted or replaced, such as β-blockers, mineralocorticoid receptor antagonists, calcineurin, non-steroidal anti-inflammatory drugs, etc. Inflammatories, trimethoprim, and heparin.

Among them, special attention should be paid to the application of renin-angiotensin-aldosterone system (RAAS) inhibitors, which have cardiorenal protective effects. If the drug is stopped or reduced, the possible adverse results should be considered.

Some patients still maintain a high level of serum potassium after initial treatment, and sodium bicarbonate and/or diuretics can be used further. The dose of sodium bicarbonate should be between 3-5g per day, which is only suitable for patients with metabolic acidosis. However, this method is poorly tolerated in patients with advanced CKD due to the risk of increased blood pressure and fluid retention.

Diuretics should be prescribed with caution to prevent patients from developing hypovolaemia, hypotension, decreased glomerular filtration rate, and recurrent hyperkalemia. In addition, exchange resins such as calcium polystyrene sulfonate, sodium polystyrene sulfonate, polyacrylate, and sodium zirconium cyclosilicate can be used for treatment.

In CKD patients on dialysis, a major barrier to potassium control is the fluctuation of serum potassium levels, which are often measured monthly and fluctuating levels may go undetected, resulting in the use of dialysis infusions during dialysis infusions. Insufficient potassium concentration in the liquid.

On the other hand, the use of dialysate with low potassium concentrations (0 or 1 mmol/L) in patients undergoing dialysis with persistently high potassium levels is controversial. It has been reported that after hemodialysis with low potassium concentration, patients will experience arrhythmia and sudden death, which may be related to the rapid decrease of extracellular ion concentration; it can be improved by prolonging the duration of dialysis, increasing the frequency of dialysis, and using new hemodialysis modes and/or potassium-binding resin solution.

summary

Hyperkalemia is a common metabolic complication in CKD patients and is associated with severe patient outcomes. The treatment of hyperkalemia includes dietary restriction of potassium intake, acute treatment, and chronic control. Comprehensively controlling the blood potassium level is a major basis for ensuring the quality of life of patients. For people with poor kidney function, avoid eating too many potassium-rich foods such as bayberry, seaweed, and kelp at one time on weekdays!

References:

[1] Borrelli S, Matarazzo I, Lembo E, Peccarino L, Annoiato C, Scognamiglio MR, Foderini A, Ruotolo C, Franculli A, Capozzi F, Yavorskiy P, Merheb F, Provenzano M, La Manna G, De Nicola L, Minutolo R, Garofalo C. Chronic Hyperkaliemia in Chronic Kidney Disease: An Old Concern with New Answers. Int J Mol Sci. 2022 Jun 7;23(12):6378. doi: 10.3390/ijms23126378. PMID: 35742822; PMCID: PMC 9223624.

[2]Watanabe R. Hyperkalemia in chronic kidney disease. Rev Assoc Med Bras (1992). 2020 Jan 13;66Suppl 1(Suppl 1):s31-s36. doi 10.1590/1806-9282.66.S1.31. PMID: 319395 33.

[3]Sarnowski A, Gama RM, Dawson A, Mason H, Banerjee D. Hyperkalemia in Chronic Kidney Disease: Links, Risks, and Management. Int J Nephrol Renovasc Dis. 2022 Aug 2;15:215-228. doi: 10.2147/ IJNRD.S326464. PMID: 35942480; PMCID: PMC9356601.