Implementing Continuous Quality Improvement Process in Potassium Management in Peritoneal Dialysis Patients

Background

Abnormal plasma potassium levels are not uncommon in peritoneal dialysis (PD) patients. Here, we implemented a continuous quality improvement (CQI) approach that mainly focused on dietary management to improve potassium control in PD patients.

Methods

All clinically stable patients who visited the PD clinic monthly were included in this study. A CQI team that included nephrologists, primary nurses, dietician, patients, and their family members was organized, and it monitored patients for 6 months. Patients were asked to provide their dialysis records and 3-day dietary records at each visit. Dialysis adequacy, including potassium and phosphorus removals, was checked before and after the implementation of CQI. Changes in dietary prescription, without altering dialysis prescriptions and potassium supplementation, were made monthly, according to patients' dietary information and blood potassium levels.

Results

In total, 84 patients (28 male and 56 female) were included in this study. At baseline, the prevalence of hyperkalemia and hypokalemia was 14.3% each. After the intervention, the prevalence of hyperkalemia dropped to 10.7% and 6% at 3 months and 6 months, respectively. The prevalence of hypokalemia dropped to 8.3% and 7.1% at 3 months and 6 months, respectively.

Conclusions

Our data suggest that implementing CQI, with a focus on dietary intervention, could significantly reduce the prevalence of potassium abnormality in PD patients.