Hyperkalemia risks in hemodialysed patients consuming fluoride-rich water

In order to observe the consequences of chronic ingestion of high fluoride- rich water on plasma potassium levels of hemodialysed subjects, we have con ducted a retrospective study on 25 patients with chronic renal failure, tre ated with a substitute method, six of whom (consumers group, group C) were drinkers of a bicarbonate (about 4500 mg/l) and fluoride-rich (9 mg/l) mine ral water, the Vichy Saint-Yorre water. With respect to sodium poilystyrene sulfonate consumption (n = 17), there was no significant difference betwee n group C and Ne (non-consumers group). A significant correlation between p lasma fluoride and potassium levels was observed only before dialysis (P < 1 X 10(-7)) but not after dialysis. A group by group analysis revealed that this correlation was linked to group C (P < 5 X 10(-6)), in which kalemia before dialysis was higher than that observed in group NC (P < 0.005). More over, it appeared that the higher fluoride levels were, the higher the kale mia was inclined to be. Thus, the risks of hyperkalemia in dialysed patient s, who also drink Vichy St-Yorre water or other fluoride-rich waters, are m ore important, while not forgetting the risk of fluorosis. The mechanisms b y which chronically administered fluoride could increase kalemia are also d iscussed. (C) 1999 Elsevier Science B.V. All rights reserved.