Hyperkalemia occurs and recurs at high rates in the hemodialysis population, investigators reported at the European Renal Association (ERA) 59th Congress. Summer is a particularly vulnerable time.

In 149 patients receiving thrice-weekly hemodialysis in Greece in June 2020, 60.4%, 42.2%, and 13.4% had serum potassium levels of 5.1 mmol/L or more, 5.5 mmol/L or more, and 6.0 mmol/L or more, respectively. Within 1 year, 85.2%, 69.8%, and 38.9% of patients experienced hyperkalemia recurrence at or above the respective serum potassium thresholds.

Among the 104 patients who experienced an initial hyperkalemia episode (serum potassium of 5.5 mmol/L or more), hyperkalemia at or above the same threshold recurred in 60.6% within 1 month, 47.1% within 2 months, and 46.1% within 3 months.

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Hyperkalemia prevalence was significantly higher in the summer, Pantelis E. Zebekakis, MD, PhD, of Aristotle University of Thessaloniki in Greece and colleagues reported.

In multivariate logistic regression analysis, hemodialysis sessions lasting less than vs more than 4 hours was significantly associated with 2.6-fold increased odds of hyperkalemia, the investigators found. High vs low potassium dialysate was significantly associated with 14.6-fold increased odds of hyperkalemia.

Hyperkalemia increases the risks for cardiovascular-related hospitalizations and sudden cardiac death, Dr Zebekakis’ team noted. They concluded that there remains a “large unmet need” for effective potassium-lowering therapies in this “high-risk” population.


Tsiagka D, Georgianos P, Pikilidou M, et al. Prevalence, recurrence and seasonal variation of hyperkalemia in patients receiving thrice-weekly haemodialysis. Presented at: ERA 59th Congress, May 19-22, 2022. Abstract MO879.