This prospective, multicenter, randomized controlled trial published in the American Journal of Kidney Diseases (AJKD) demonstrated that, compared with a reactive strategy of potassium supplementation when serum potassium fell below 3.5 mEq/L, a protocol-based potassium supplementation strategy to maintain serum potassium in the target range of 4-5 mEq/L resulted in a longer time (90 days) to the first peritonitis episode, a lower hazard ratio of peritonitis, and a lesser proportion of free-peritonitis participants.
Hypokalemia is commonly found in patients on peritoneal dialysis (PD) and associated with poor outcomes. A multicenter, open-label, prospective, randomized controlled trial was conducted in 167 hypokalemic patients receiving PD. It examined if a protocol-based correction of hypokalemia to maintain serum potassium 4-5 mEq/L (85 participants) could improve PD-related outcomes compared to reactive potassium supplementation administered when serum potassium levels fell below 3.5 mEq/L (82 participants). During the median follow-up time of 401 days, the protocol supplementation appeared safe and significantly reduced the risk of peritonitis. Potassium chloride tablets at the dosage used in this study (25±13 mEq/day) demonstrated promising efficacy and relatively few side effects. Most participants in the study tolerated the medications well, with only a tiny number discontinuing treatment due to adverse effects. Notably, only 4% of participants in the intervention group experienced asymptomatic hyperkalemia.