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Hypokalemia is common among peritoneal dialysis (PD) patients. It is estimated to affect one-third of all PD patients and may have contributed to the poor clinical outcome associated with general and sudden death among patients with cardiovascular disease, increase infection-related mortality and peritonitis risk. In results of PDOPPS patients with lower potassium (<3.5 mEq/l) were less likely to use Automated Peritoneal Dialysis (APD). Previously trials did not found difference in mean potassium serum levels after switching to from APD to Continuous Ambulatory Peritoneal Dialysis (CAPD) and viceversa. The objective of this study is to evaluate changes in serum potassium when transitioning a patient from CAPD to APD.
A retrospective study was conducted of a cohort of 82 patients who were in CAPD and subsequently switched APD. The follow-up period extended to 7 months, 4 months in CAPD, and 3 months in APD. Patients older than 18 were included, regarding sex or cause of kidney disease. For comparisons between two groups, the Student t-test was used for related variables, as well as X 2 for discrete variables. The primary classification criteria involved calculating the average of measurements over different months, especially for determining potassium levels. To examine the factors associated with the decrease in potassium levels, a general linear regression model was employed, enabling the identification of variables with the most significant impact. Furthermore, a multivariate analysis was conducted, considering potential confounding variables.
The average age was 55.8±15.7 years, with a predominant male gender accounting for 53 (64%) of the population. Among this group, hypertension was the primary etiology for chronic kidney disease in 48.8% of cases, followed by diabetes in 43.9%. Regarding the type of peritoneal transport, the highest percentage fell within the high and high-average categories, both for CAPD (80.5%) and APD (81.7%). Icodextrin use was reported by 54% of patients in both therapies. A substantial percentage of patients used diuretics in both CAPD (76.8%) and APD (74.4%). For clinical variables, a statistically significant mean difference was observed only for potassium (CAPD: 4.64±0.81; APD: 4.50±0.74, p-value 0.05) and calcium (CAPD: 8.74±0.68; APD: 8.95±0.83, p-value 0.05). Multiple regression analysis revealed that wet day (ß=0.010, p=0.003) and potassium levels from the previous therapy, specifically the potassium levels 2 months before switching to APD (ß=0.605, p<0.001), were associated with lower potassium levels in the new therapy. Additionally, calcium was subjected to a secondary analysis due to its statistical significance in the context of therapy change. This analysis indicated a strong relationship between age (ß=0.011, p=0.029) and calcium levels measured 2 months before the switch to APD (ß=0.740, p<0.001).
The study revealed that wet days and potassium levels 2 months before switching therapy from CAPD to APD were associated with a decrease in potassium. In addition, age and calcium levels from CAPD previous therapy are associated with higher levels of calcium in the APD. Findings suggest that clinicians should be aware of the potential for hypokalemia in patients transitioning from CAPD to APD. Close monitoring of serum potassium levels is recommended in the initial months after switching therapies.