Nebulized albuterol for acute hyperkalemia in patients on hemodialysis

Study Objective: To determine the efficacy and safety of nebulized albuterol in the acute treatment of hyperkalemia in patients on chronic hemodialysis. Design: Prospective, double-blind, and placebo-controlled study. Setting: Outpatient hemodialysis clinic at a university medical center. Patients: Ten patients on maintenance hemodialysis who had chronic hyperkalemia. Interventions: Patients received nebulized albuterol therapy (10 mg or 20 mg) or placebo (saline) on three separate occasions; serial measurements of plasma potassium levels, blood pressure, and pulse were then taken for a 2-hour period. Measurements and Main Results: Patients had a significant decrease in plasma potassium concentrations that was evident by 30 minutes and sustained for at least 2 hours after albuterol treatment. After the administration of 10- and 20-mg doses of albuterol, the maximal decrease in the plasma potassium levels was 0.62 ± 0.09 and 0.98 ± 0.14 mmol/L (SE), respectively. Nebulized saline administration did not produce a significant change in the plasma potassium concentrations. Patients did not develop symptoms or significant changes in blood pressure or heart rate with albuterol treatment. Conclusions: In the doses used, nebulized albuterol therapy resulted in a prompt and significant decrease in the plasma potassium concentrations in patients on hemodialysis, and caused no adverse cardiovascular effects. This treatment should be considered as an important adjunct for acute treatment of serious hyperkalemia in this population of patients.