Association of Hypokalemia Duration and First Episode Peritonitis in Patients on Peritoneal Dialysis: A Single-Center, Retrospective Analysis

Background: Hypokalemia is a common condition in end-stage renal disease (ESRD) patients undergoing peritoneal dialysis (PD). Peritonitis is one of the most common complications associated with peritoneal dialysis. PD-associated peritonitis (PDAP) carries high morbidity for PD patients, which can cause catheter loss and transition to hemodialysis. First episode of peritonitis affects survival of peritoneal membrane as well as survival of PD patients. Several previous studies were done to determine association the association of hypokalemia and peritonitis. However, previous studies have differing results on the association of hypokalemia and PDAP. Methods: A single center retrospective study design was conducted in the National Kidney and Transplant Institute, Philippines, reviewing patients initiated with peritoneal dialysis and had first-episode peritonitis from January 2018 to December 2022. A total of 336 patients were included. Hypokalemia duration was calculated as the total number of months that a patient’s serum potassium level was continuously below 3.5 mmol/L. Results: Most patients (246, 73.4%) with first-episode peritonitis had hypokalemic episodes. Shorter duration of hypokalemia had significant association with the peritonitis (p=0.004). Specifically, 50.4% (169) had hypokalemia for a duration of 1-3 months, while 12.2% (41) for 4-6 months and 10.7% (36) for >6 months. It is noteworthy that among hypokalemic patients with peritonitis in the first year, 41% (49 of 117) had early-onset peritonitis and most of these patients (39, 73%) had hypokalemia in the first 3 months of peritoneal dialysis. Pseudomonas aeruginosa in Gram-negative, and Streptococcus spp in Gram-positive bacteria were the main organisms in this study. Hypokalemic patients had significantly higher incidence of Staphylococcus aureus than patients without hypokalemia. Conclusion: Most patients with PD-associated peritonitis were hypokalemic and most had hypokalemia duration of only 1-3 months. This signifies that PDAP can occur even with the shortest duration of hypokalemia.