Serum potassium level higher than 5.5mmol/l is called hyperkalemia. The main causes of hyperkalemia are too much intake, reduced excretion, disorganization and abnormal distribution.
The reduced excretion of potassium in the kidneys is one of the major reasons of elevated blood potassium. Under normal circumstances the healthy kidney has strong regulating ability of K+, however in case of kidney failure, patients are susceptible to hyperkelemia due to organic and functional damages.
Many factors can affect the body's tolerance to hyperkalemia. For kidney failure patients, their regulation ability of blood potassium experiences obvious decline, so does their tolerance to high blood potassium. What is more, acidosis and acid-base are also important factors affecting our body's tolerance to serum potassium concentration.
When GFR falls to 20-25ml/min or even lower, the kidney's ability of excretion of potassium will be affected and patients will have hyperkalemia especially in case of too much intake of potassium, acidosis, infections, physical traumas, gastrointestinal hemorrhage, etc.
Hyperkalemia can cause severe damages to functions of the heart and respiratory muscles. Severe hyperkalemia (serum potassium >6.5mmol/l) is relatively dangerous and proper treatments should be received as soon as possible.
1. Limit the intake of potassium
When GFR<25ml/min or creatinine>3.5-4mg/dl, daily potassium intake should be limited within 1500-2000mg;
When GFR<10ml/min or creatinine>5.5, daily potassium intake should be less than 1000mg/d.
2. Rectifying acidosis. Acidosis can cause further increase of the concentration of blood potassium. Patients can have oral intake of sodium bicarbonate and if necessary intravenous injection can be done.
3. Application of diuretic. Proper amount of diuretic can help increase excretion of potassium in urine.
4. Hemodialysis. In case of blood potassium higher than 6.5mmol/l and the diuretic effect is not very good and patients also have oliguria, hemodialysis should be offered timely.
However sometimes patients can have hypokalaemia which is lower than normal blood potassium level. This is due to inadequate intake of potassium, too much loss in the gastrointestinal tract and diuretic.
Besides hyperkalemia, kidney failure especially advanced kidney failure patients will have metabolic disorders of water and other electrolytes such as sodium, phosphorus, calcium, etc.
To rectify these metabolic disorders and recover normal internal environment, kidney failure patients need more effective treatments to recover certain kidney functions so that these excessive water and electrolytes will be discharged naturally.
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