Although the surfacing of hemodialysis has enabled nephrologists to enhance the quality-of-life of the individuals, potassium balance is one of the dangers that accompany end-stage renal disease (ESRD) cases along with an increase in mortality rates. The annual mortality rates of hemodialysis patients in India have been estimated to be 9-13%. According to data available, evidence had shown significant adverse impact of dyskalemia on life expectancy in patients receiving hemodialysis; wherein both hypo- and hyperkalemia can cause potentially fatal cardiac arrhythmias and sudden death.Kidney plays a vital role in maintaining potassium ([K]) homeostasis by excreting excess potassium; potassium excretion depends primarily on renal excretion (about 90%) and to a lesser extent (about 10%) on colonic excretion. However, it is the non-renal excretion of [K] and dialytic [K] removal, that plays a significant role in maintaining potassium balance in ESRD patients on hemodialysis because of markedly decreased renal excretion of potassium. Hypokalemia and a low potassium level, defined as serum potassium levels of <3.5 mmol/L and <4.0 mmol/L, respectively, occurring in 2% and 13% of patients receiving hemodialysis, respectively is an independent prognostic factor of hemodialysis. Malnourishment, metabolic alkalosis, potassium binders, and low potassium dialysate are risk factors for hypokalemia.Furthermore, hypokalemia is associated with increased risk of ventricular arrhythmias in patients with underlying cardiac diseases and a higher incidence of ventricular arrhythmias; the incidence increases from 9 to 40% during hemodialysis.
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