This is a definitive therapy in patients with end-stage renal disease, severe CKD, acute kidney injury, or it there is a comorbidity such as digitalis toxicity or rhabdomyolysis. It is the most efficacious means of removing K+, with serum K+ decreasing by 1 mmol/L in the first hour and 2 mmol/L by 2-3 hours.
A lower K+ dialysate concentration and an increased blood flow rate into the dialysis machine can decrease the serum K+ level at a greater rate. Hemodialysis should be considered early in management of patients with known or established renal failure, oliguric acute renal injury, resistance to other treatments such as with loop diuretics, and with marked tissue destruction.
- Mechanism of Action: Preferentially binds K+ throughout GI tract
- Onset of Action: 1-8 hours
- Duration of Effect: 4-12 hours
- Adverse Effects:
- Pearls: Most efficacious means of removing K+; must be considered early for patients with renal failure or injury, marked tissue destruction, and those unresponsive to other hyperkalemia treatments, K+ removed from the body: 25-50 mEq/h