Impact of convective clearance on intra‐dialytic potassium removal in chronic dialysis patients

Abstract Introduction Hyperkalemia is frequently encountered and associated with cardio‐vascular mortality in chronic hemodialysis (HD) patients. While online hemodiafiltration (OL‐HDF) is thought to offer clinical benefit over high‐flux HD, the impact of convective clearance on intra‐dialytic potassium removal is unknown. Methods Chronic dialysis patients undergoing outpatient HD or OL‐HDF at a single center attached to a university hospital were recruited in a prospective observational study. Spent dialysate along with clinical and biological variables were collected during a single mid‐week session. Results We included 141 patients, with 21 treated with HD and 120 with OL‐HDF. Mean age was 65.7 ± 15.6 years with 87 (61.7%) men. Mean intra‐dialytic potassium removal was 69.9 ± 34.2 mmol. Patients on OL‐HDF and HD have similar intra‐dialytic potassium removal, with mean values of 69.1 ± 34.2 and 74.3 ± 35.0, respectively. In multivariate analysis, factors associated with intra‐dialytic potassium removal were (decreasing order of effect size): dialysate potassium ( β −15.5, p < 0.001), pre‐HD serum potassium ( β 9.1, p < 0.001), and session time ( β 7.8, p = 0.003). In OL‐HDF patients, substitution flow was not associated with potassium removal. Conclusion In chronic dialysis patients, convective therapy provided by OL‐HDF does not affect potassium removal when compared with high‐flux HD. Moreover, the importance of convective volume is not associated with potassium clearance in OL‐HDF. Overall, session length and serum‐to‐dialysate potassium gradient are the main determinants of potassium clearance regardless of dialysis modality. Those results should inform clinicians on the optimal therapy in chronic dialysis patients in the era of OL‐HDF.