Table 1 Literature review of the relationship between the dialysate potassium concentration and arrhythmia in patients undergoing HD

Morrison et al.

1980

The USA

2, 3.5

A significant reduction in the frequency of ventricular ectopy was confirmed with the use of 3.5 mEq/L potassium dialysates

[23]

Redaelli et al.

1996

Italy

2.1–4.1 (mean potassium levels)

A reduction in the plasma-dialysate potassium concentration gradient significantly led to the decrease in HD-induced arrhythmia in patients undergoing regular HD treatment

[21]

Karnik et al.

2001

North America

0, 1, 2, 2.5, 3, 4

The cardiac arrest rate was a 7 per 100,000 hemodialysis sessions (400 events of 5,744,708 HD session). Case patients were twice as likely to have been dialyzed against a 0 or 1.0 mEq/L potassium dialysate on the day of cardiac arrest

[24]

Kovesdy et al.

2007

The USA

< 1.0, 2.0, 3.0, > 3.0

In total, 8679 all-cause deaths were observed. The highest risk of death was observed among patients with a serum potassium concentration of > 5 mEq/L exposed to a dialysate potassium concentration of > 3; however, no increased risk of mortality was associated with a dialysate potassium concentration of < 2 mEq/L among patients with a serum potassium concentration of > 5 mEq/L

[7]

Al-Ghamdi et al.

2010

Canada

0 or 1, 2, 3 4

In total, 515 all-cause deaths were observed. There were no independent associations between lower dialysate potassium concentrations and the risk of mortality compared to a dialysate potassium concentration of 2 mmol/L

[25]

Pun et al.

2011

The USA

1, 2, 3 4

In total, 502 SCDs were observed, and the cardiac arrest rate 4.5 per 100,000 HD treatments. For pre-dialysis serum potassium levels (< 5 mEq/L), the difference in risk between those treated with a low (< 2 mEq/L) and high (> 2 mEq/L) potassium dialysate concentrations increases, but among subjects with higher pre-dialysis serum potassium levels (≥ 5 mEq/L), there was no significant difference in the risk based on the potassium dialysate level

[26]

Jadoul et al.

2012

12 countries in the DOPPS

≤ 1.5, 2–2.5, ≥ 3

In total, 1734 sudden deaths were observed, and dialysate potassium concentrations of ≤ 1.5 mEq/L and 2–2.5 mEq/L were associated with a higher risk of SCD compared to concentrations of ≥ 3.0 mEq/L

[19]

Flythe et al.

2014

North America

1, 2, > 2

In total, 924 cardiopulmonary arrests were observed, and the use of 1 mEq/L potassium dialysate was associated with an increased risk of cardiopulmonary arrests

[27]

Buiten et al.

2014

The Netherlands

1.6, 2 (mean potassium levels)

In patients with an implantable cardioverter defibrillator undergoing dialysis, 428 episodes of AF were observed. In patients with AF episodes, the potassium dialysate concentration was lower than that in patients without AF (1.6 mEq/L vs. 2 mEq/L)

[28]

Huang et al.

2015

Taiwan

1, 2, 2.5, 3

In total, 31 SCDs were observed. Using 1.0 mEq/L potassium dialysate in patients with hyperkalemia undergoing HD (> 5.5 mEq/L) and adequate adjustment of dialysate composition in patients with normo- or hypokalemia undergoing HD from 1.0 mEq/L potassium dialysate could reduce the rate of SCD

[29]

Karaboyas et al.

2017

20 countries in the DOPPS

1–1.5, 2–2.5, 3–4

In total, 13,114 deaths and 3300 composite events related arrythmias were observed. No meaningful difference in clinical outcomes was observed for patients treated with a dialysate potassium concentration of 3 and 2 mEq/L for both mortality and composite arrhythmia events

[2]

Ferrey et al.

2018

The USA

1, 2, 3

A dialysate potassium concentration of 1 mEq/L was associated with a higher risk of mortality in patients with higher serum potassium concentrations (≥ 5 mEq/L), but not in those with lower serum potassium concentrations (< 5 mEq/L)

[30]

Brunelli et al.

2018

The USA

1, 2, 3, 4

There was a dose–response relationship between higher K+ gradient [(serum K⁺) – (dialysate K⁺)] and greater risks of all-cause hospitalization and emergency department visit

[22]

Delanaye et al.

2021

Belgium

1, 3

An increase of 1 mEq/L in the dialysate potassium level was associated with a lower risk of hypokalemia and a lower QT dispersion on electrocardiogram after HD session

[31]