MINERALOCORTICOID THERAPY LOWERS SERUM POTASSIUM IN PATIENTS WITH END-STAGE RENAL-DISEASE

Hyperkalemia is a commonly encountered problem in dialysis patients wi th end-stage renal disease. In this study we evaluated the effect of m ineralocorticoid therapy (MCT; fludrocortisone 0.1-0.3 mg per os daily ) on serum potassium of hyperkalemic end-stage renal disease patients. Consecutive monthly clinical and biochemical profiles 3-6 months befo re and after MCT were compared. Twenty-one patients with a mean age (/- SE) of 54 +/- 4 years (11 male and 10 female) were studied. Two pat ients were dropped from this study because they required a change in p rescription of dialysis after starting MCT. Mean serum potassium level s significantly fell (p < 0.001) during the post-MCT period (4.9 +/- 0 .1 mEq/l) compared with potassium levels during the pre-MCT (5.6 +/- 0 .1 mEq/l) period. All patients except 1 showed a reduction in serum po tassium levels after MCT. Pre- and post-MCT values were not different for body weight, mean blood pressure, blood urea nitrogen, serum gluta mic-oxaloacetic transaminase, lactate dehydrogenase, sodium, chloride, bicarbonate, creatinine and albumin. Since the majority of the patien ts were anuric (n = 15), a decrease in serum potassium values in the p ost-MCT period was not due to loss of potassium in the urine. MCT appe ars to decrease serum potassium values in patients with end-stage rena l disease by extrarenal mechanisms. We conclude that MCT can be used s afely to lower serum potassium in patients with end-stage renal diseas e.