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Hypokalemia and hyperkalemia in patients on peritoneal dialysis: incidence and associated factors

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Hypokalemia is a well-described electrolyte disturbance in patients on peritoneal dialysis (PD). Hyperkalemia, however, is still overlooked, although it also represents a risk factor for mortality. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (ACE/ARB), diuretics, and proton pump inhibitor (PPI) can interfere with potassium levels in these patients.


This is a retrospective study that evaluated monthly serum potassium in a 5-year period. Serum potassium disturbances were evaluated as time-average and number of hypo- and hyperkalemia episodes per patient. Prescribed medication such as ACE/ARB, diuretics, and omeprazole were recorded.


We evaluated 2025 potassium measurements obtained from 146 patients on PD. Serum potassium ranged from 2.5 to 8.3 mEq/L with an average of 4.72 ± 0.74 mEq/L. Hypokalemia was found in 59 measurements (2.9%) obtained from 35 patients (23.9%) whereas hyperkalemia was demonstrated in 269 (13.3%) measurements obtained from 74 patients (50.7%). Hypokalemia was associated with low albumin (p = 0.022), and omeprazole use (p = 0.024). Black race was a protector factor (p = 0.031). Omeprazole-associated hypokalemia was seen only in non-anuric patients and remained an independent risk factor even after adjustments. Patients who had hyperkalemia were more likely to be anuric (p = 0.001) and in use of furosemide (p = 0.0001).


Hyperkalemia and hypokalemia are very frequent in patients on PD and should be closely monitored. Interventional studies should address the impact of discontinuing omeprazole in the levels of potassium.

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We thank Fatima Libanio for her assistance with electronic data collection.


RMAM and RME are supported by CNPq, Conselho Nacional de Desenvolvimento Científico e Tecnológico (Grant Numbers 304249/2013-0 and 305106/2018-0, respectively). This financial support had no role in study design; collection, analysis and interpretation of data; writing the report; and the decision to submit the report for publication.

Author information

Contributions to the conception and study design: FAG and RME; Data collection and analysis: RME. Data interpretation: RME, RMAM. Drafting of the manuscript: RME, RMAM. Revising manuscript content and approval of the final version of the manuscript: FAG, LCC, LC, MCTP, LKRPA, CSW, BCS, BJP, RMAM and RME. RME takes responsibility for the integrity of the data analysis.

Correspondence to Rosilene M. Elias.

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We have read and understood Peritoneal Dialysis International’s policy on disclosing conflicts of interest and declare that we have none.

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Goncalves, F.A., de Jesus, J.S., Cordeiro, L. et al. Hypokalemia and hyperkalemia in patients on peritoneal dialysis: incidence and associated factors. Int Urol Nephrol 52, 393–398 (2020). https://doi.org/10.1007/s11255-020-02385-2

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  • Hyperkalemia
  • Potassium
  • Proton-pump inhibitor
  • Black race
  • Anuria