For maintenance hemodialysis patients with a history of ventricular tachycardia or ICD shocks, do you target a pre-dialysis serum potassium ≥ 4.5 mEq/L or routinely use high potassium baths?

Yes. These are patients most at risk of arrhythmias from dialysis-induced hypokalemia. Hyperkalemia is usually better tolerated. As long as the pre-dialysis potassium is < 6 mEq/L, then 3K bath, or at times even 4K bath is preferred. If the pre-dialysis K is > 6 mEq/L, then I would consider an extra...

A few points worth making:

First, there are no data specifically applicable to this high-risk setting.

Second, the idea of targeting a pre-dialysis K has limited meaning since few centers will check this more than once a month.

The risk of arrhythmia-inducing low K (or a rapid intradialytic decline ...