March 2021

Subject: Hemodialysis Treatment of Patients with Severe Hyperkalemia

Purpose: To define the process and parameters of providing safe hemodialytic management of severe hyperkalemia.

Rationale: Severe hyperkalemia (Serum Potassium≥7.0) is a life-threatening condition which is managed with acute hemodialysis treatment. However, both hyperkalemia itself and rapid dialytic changes in serum potassium levels have the potential of inducing life threatening cardiac arrhythmias. Therefore, dialysis should be performed under central telemetry-monitored conditions with appropriate staff oversight whenever possible. However, the clinical situation may dictate that the need for expedient dialysis to correct hyperkalemia may outweigh the risks of intradialytic cardiac events.

Policy:

1. All patients who are known to have a severe hyperkalemia (Serum Potassium≥7.0) prior to initiating dialysis treatment should undergo dialysis in a telemetry monitored unit instead of the 3B Dialysis unit.
2. Any exceptions to this policy must be approved by and documented in the chart by the nephrology consult attending.
3. There will be no exceptions to this policy for emergent dialysis initiated for severe hyperkalemia (Serum Potassium≥7.0) after normal operating hours (Monday-Saturday, 7AM to 6PM).