Abstract: Objective  The aim of this study was to observe the effect of the Chinese hyperkalemia risk assessment tool in maintenance hemodialysis (MHD) patients.   Methods   A total of 280 MHD patients from the three hospitals in the Suzhou New District were enrolled in this study. The control group (n=142) was given routine prevention and treatment methods for hyperkalemia. The experimental group (n=138) used Find, Organize, Clarify, Understand, Select, –Plan, Do, Check, Act (FOCUS-PDCA) model for graded intervention based on the risk level of hyperkalemia. The hyperkalemia related indexes were compared before and after the intervention.  Results  After 24 weeks of intervention, the prevalence of hyperkalemia (13.8% vs. 23.9%, c2=4.722, P=0.030) and blood potassium level (4.44±0.35 vs. 4.58±0.47mmol/l, t=2.850, P=0.005) were significantly lower in the experimental group than in the control group; the dialysis adequacy [1.32(1.22～1.54) vs. 1.24(1.20～1.30), Z=-5.360, P<0.001] and quality of life (63.79±14.59 vs. 56.30±16.29, t=-4.004, P<0.001) were significantly higher in the experimental group than in the control group. After 12, 18 and 24 weeks of intervention, the prevalence of hyperkalemia (36.2% vs. 31.2% vs. 27.5% vs. 13.8%, x2=19.37, P<0.001) and blood potassium level (5.02±0.43 vs. 4.81±0.42 vs. 4.68±0.39 vs. 4.44±0.35 mmol/L, F=51.52, P<0.001) in the experimental group decreased gradually along with the intervention duration. After 24 weeks of intervention, 31 extreme-risk or high-risk patients (22.4%) turned to moderate-risk level (Z=16.326, P=0.001).  Conclusion  Based on the hyperkalemia risk assessment tool, the hierarchical management of MHD patients through FOCUS-PDCA model can significantly reduce potassium level and risk of hyperkalemia, and improve dialysis adequacy and quality of life. This method is worthy of promotion for clinical application.

Key words: Hyperkalemia risk assessment tool, Maintenance hemodialysis, Grading management, Continuous quality improvement