Hyperkalemia risks in hemodialysed patients consuming fluoride-rich water.

In order to observe the consequences of chronic ingestion of high fluoride-rich water on plasma potassium levels of hemodialysed subjects, we have conducted a retrospective study on 25 patients with chronic renal failure, treated with a substitute method, six of whom (consumers group, group C) were drinkers of a bicarbonate (about 4500 mg/l) and fluoride-rich (9 mg/l) mineral water, the Vichy Saint-Yorre water. With respect to sodium polystyrene sulfonate consumption (n = 17), there was no significant difference between group C and NC (non-consumers group). A significant correlation between plasma fluoride and potassium levels was observed only before dialysis (P < 1 x 10(-7)) but not after dialysis. A group by group analysis revealed that this correlation was linked to group C (P < 5 x 10(-6)), in which kalemia before dialysis was higher than that observed in group NC (P < 0.005). Moreover, it appeared that the higher fluoride levels were, the higher the kalemia was inclined to be. Thus, the risks of hyperkalemia in dialysed patients, who also drink Vichy St-Yorre water or other fluoride-rich waters, are more important, while not forgetting the risk of fluorosis. The mechanisms by which chronically administered fluoride could increase kalemia are also discussed.