A Randomized Controlled Trial of Fludrocortisone for the Treatment of Hyperkalemia in Hemodialysis Patients

Kaisar, Mohammed O., Wiggins, Kathryn J., Sturtevant, Joanne M., Hawley, Carmel M., Campbell, Scott B., Isbel, Nicole M., Mudge, David W., Bofinger, Andrew, Petrie, James J.B. and Johnson, David W. (2006) A Randomized Controlled Trial of Fludrocortisone for the Treatment of Hyperkalemia in Hemodialysis Patients. American Journal of Kidney Diseases, 47 5: 809-814. doi:10.1053/j.ajkd.2006.01.014

Author Kaisar, Mohammed O.
Wiggins, Kathryn J.
Sturtevant, Joanne M.
Hawley, Carmel M.
Campbell, Scott B.
Isbel, Nicole M.
Mudge, David W.
Bofinger, Andrew
Petrie, James J.B.
Johnson, David W.
Title A Randomized Controlled Trial of Fludrocortisone for the Treatment of Hyperkalemia in Hemodialysis Patients
Journal name American Journal of Kidney Diseases   Check publisher's open access policy
ISSN 0272-6386
Publication date 2006-05
Sub-type Article (original research)
DOI 10.1053/j.ajkd.2006.01.014
Volume 47
Issue 5
Start page 809
End page 814
Total pages 6
Editor B. L. Kasiske
Place of publication Maryland Heights, MO, United States
Publisher W B Saunders
Collection year 2006
Language eng
Subject C1
730118 Organs, diseases and abnormal conditions not elsewhere classified
110312 Nephrology and Urology
Formatted abstract
Background: Previous small uncontrolled studies suggested that fludrocortisone may significantly decrease serum potassium concentrations in hemodialysis patients, possibly through enhancement of colonic potassium secretion. The aim of this study is to evaluate the effect of oral fludrocortisone on serum potassium concentrations in hyperkalemic hemodialysis patients in an open-label randomized controlled trial.

Methods: Thirty-seven hemodialysis patients with predialysis hyperkalemia were randomly allocated to administration of either oral fludrocortisone (0.1 mg/d; n = 18) or no treatment (control; n = 19) for 3 months. The primary outcome measure was midweek predialysis serum potassium concentration, which was measured monthly during the trial. Prospective power calculations indicated that the study had an 80% probability of detecting a decrease in serum potassium levels of 0.7 mEq/L (0.7 mmol/L).

Results: Baseline patient characteristics were similar, except for slightly longer total weekly dialysis hours in the fludrocortisone group (13.0 ± 1.3 versus 12.1 ± 1.0; P = 0.02). At the end of the study period, no significant changes in serum potassium concentrations were observed between the fludrocortisone and control groups (4.8 ± 0.5 versus 5.2 ± 0.7 mEq/L [mmol/L], respectively; P = 0.10). Similar results were obtained when changes in serum potassium levels over time were examined between the 2 arms by using repeated-measures analysis of variance, with or without adjustment for total weekly dialysis hours. Secondary outcomes, including predialysis mean arterial pressure, interdialytic weight gain, serum sodium level, and hospitalization for hyperkalemia, were not significantly different between groups. There were no observed adverse events.

Conclusion: Administering fludrocortisone to hyperkalemic hemodialysis patients is safe and well tolerated, but does not achieve clinically important decreases in serum potassium levels.
Keyword Urology & Nephrology
Fludrocortisone Acetate
Chronic Kidney Failure
Mineralocorticoid Therapy
Serum Potassium
Q-Index Code C1
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2007 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 13 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 16 times in Scopus Article | Citations
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Created: Wed, 15 Aug 2007, 08:18:36 EST