MEDizzy - Your patient with end-stage renal disease on hemodialysis

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Disorders of the Kidney and Urinary Tract

Your patient with end-stage renal disease on hemodialysis has persistent hyperkalemia. He has a history of total bilateral renal artery stenosis, which is why he is on hemodialysis. He only has electrocardiogram changes when his potassium rises above 6.0 mEq/L, which occurs a few times per week. You admit him to the hospital for further evaluation. Your laboratory evaluation, nutrition counseling, and medication adjustments have not impacted his serum potassium. What is the next reasonable step to undertake for this patient?

ExplanationThe potassium concentration of dialysate is usually 2.5 mEq/L VII-19. The answer is A. (Chap. 336) The potassium concentration of dialysate is usually 2.5 mEq/L but may be varied depending on the predialysis serum potassium. This patient may need a lower dialysate potassium concentration. Sodium modeling is an adjustment of the dialysate sodium that may lessen the incidence of hypotension at the end of a dialysis session. Aldosterone defects, if present, are not likely to play a role in this patient since his kidneys are not being perfused. Therefore, a nephrectomy is not likely to control his potassium. Similarly, since the patient is likely anuric, there is no efficacy in using loop diuretics to affect kaluresis. This patient has no approved indications for the implantation of a defibrillator.