Evaluating the Successful Initiation of a New Dialysate Potassium Management Protocol: “Reduced Emergency Department Admission with Hyperkalemia in Hamad General Hospital Dialysis Population in Qatar”

Background

Hamad General Hospital (HGH) is the main provider of Hemodialysis (HD) treatment in Qatar. Potassium disorders, hyperkalemia, and hypokalemia are the most common electrolyte disturbances associated with life threating arrhythmias among dialysis patients. Interdialytic uncontrolled dietary intake (especially Dates) contributes to the spike of serum potassium. In spite of using low potassium bath of 1.0 mmol/L (normal 2.0 mmol/L), among patients admitted in the Emergency Department (ED) for emergency dialysis in December 2021, 16 of them (12%) had hyperkalemia. New guidelines for using various potassium buffer solution were proposed aiming to reduce the HD patient admission to the ED with hyperkalemia from 12% to <2% between January 2022 and January 2023, and to reduce the number of patients using low potassium buffer solution in the Dialysis units.

Methods

A multidisciplinary team was formed in February 2022 and the potassium dialysate protocol was updated. Patients were educated by nurses, physicians, dieticians, and patient educators. A pilot study was conducted among 28 patients. High-risk patients were monitored for serum potassium during every dialysis session, results were reviewed, and prescriptions for potassium bath were modified accordingly. The pilot being beneficial, the project eventually included all HGH dialysis patients. Data were collected and analyzed from ED admission of dialysis patients who had dialysis due to hyperkalemia.

Results

ED admission of dialysis patients with hyperkalemia which require dialysis reduced from 12% to 0% (Figure 1) and the number of patients who are using low potassium bath of 1.0 mmol/L in Dialysate solution decreased from 56 in Jan 2022 to 7 patients in June 2023 (Figure 2)

Conclusion

The new potassium protocol was found to be very effective, and has a direct impact on the quality and safety of HD patients. It reduced ED and hospital admissions, reducing the bed crisis and financial costs.