Chronic kidney disease (CKD) is a global public health issue and has a strong link with conditions like cardiovascular disease and diabetes. A systematic review and analysis published in 2022 estimated the prevalence of CKD in Asia and noted the absolute number of individuals with CKD in India to be up to 140.2 million. Kidneys are involved in regulating fluid and electrolytes in the body. Conditions like CKD and end-stage renal disease (ESRD) are associated with potassium derangements, metabolic acidosis, etc.
The extracellular fluid has only 2% of the total potassium while the intracellular fluid has most of the body’s potassium (98%). Kidneys maintain the body’s potassium homeostasis and remove the excess potassium. However, in patients with ESRD undergoing hemodialysis, non-renal potassium excretion and dialytic removal play a crucial role in potassium balance as renal excretion is decreased. Potassium derangements, including hyperkalemia and, to a lesser extent, hypokalemia, can be seen in patients with CKD.
This article focuses on hypokalemia in CKD and dialysis patients and management of hypokalemia, including the role of potassium supplementation.