Association Between Ringer’s Lactate Solution and Hyperkalemia in Patients with Reduced Kidney Function
Abstract:
Background: The use of Ringer’s lactate (RL) intravenous fluid in patients with advanced chronic kidney disease (CKD) is often avoided due to concerns about hyperkalemia (Rajasekaran et al., 2022; McGee & Lim, 2020). [3] Evidence supporting this concern remains limited and conflicting.
Objective: To determine whether the use of Ringer’s lactate is associated with the development of hyperkalemia in hospitalized patients with significantly reduced kidney function, particularly those with an estimated glomerular f iltration rate (eGFR) 5.5 mEq/L. Relative risk (RR) with 95% confidence intervals (CI) was calculated, and Cox proportional hazards regression was performed adjusting for sex, admission potassium, diabetes mellitus, diuretic use, and ACE inhibitor or ARB therapy. A p value <.05 was considered statistically significant.
Results: A total of 138 patients met inclusion criteria. The mean age was 74.6 years (range 46–105; median 76.5; SD 11.4). Most patients had hypertension and diabetes mellitus, and 75% were receiving diuretics upon admission. Ringer’s lactate was administered to 21 patients (15.2%). Hyperkalemia occurred in 27 patients (19.6%). The inci dence of hyperkalemia was higher in patients receiving RL compared with those not exposed (38.1% vs. 16.2%; RR = 2.35, 95% CI [1.19, 4.64]). After adjusting for confounders, RL exposure remained independently associated with hyperkalemia (hazard ratio [HR] = 2.76, 95% CI [1.13, 6.73]). Diuretic use was also independently associated with hyperkalemia (HR = 2.83, 95% CI [1.14, 7.02]).
Conclusion: In patients with advanced CKD, exposure to RL was associated with an increased risk of hyperkalemia. Although RL use was infrequent, careful consideration and close potassium monitoring are warranted when pre scribing RL in this population.
