Prolonged beta-adrenergic stimulation: A new way to reduce plasma potassium concentration in hemodialysis patients

Hyperkalemia is common in patients undergoing hemodialysis. A hypokalmeic e ffect from acute administration of beta-adrenergic agonists has been report ed in patients on dialysis. However, the role of prolonged beta-adrenergic stimulation in potassium homeostasis has not been evaluated. We studied the potential usage of prolonged oral beta-adrenergic stimulation (albuterol, 2 mg twice a day for 2 weeks) on the pre-dialysis plasma potassium concentr ation in 12 patients on hemodialysis. Three of the 12 patients withdrew fro m the study because of unacceptable palpitations and tremor. In the other 9 patients, the total mean pre-dialysis plasma potassium concentration decre ased from 5.04+/-0.48 to 4.44 +/- 0.54 mmol/L (p<0.05) after 2 weeks of ora l albuterol. In 3 of those patients, the plasma potassium concentration was the same before and during albuterol administration, whereas in the other 6 it decreased from 5.08 +/- 0.6 to 4.13 +/- 0.33 mmol/L (p<0.01). Furtherm ore, in these patients there was a correlation between plasma potassium con centration at baseline and the magnitude of the decrease in potassium durin g albuterol administration (r=0.84, p<0.05). These data suggest that prolon ged oral beta-adrenergic stimulation with albuterol reduces the plasma pota ssium concentration in hemodialysis patients. This decrease seems to be gre ater in subjects with greater hyperkalemia. However, 30% of the patients pr oved to refractory to the potassium-lowering effects of prolonged oral beta -adrenergic stimulation.