Kidney Week

Abstract: FR-PO402

Impact of Electrolytes and Acid-Base Changes During Hemodialysis Session on Incidence of Arrhythmia

Session Information

• Hemodialysis and Frequent Dialysis - III
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Anno, Emi, Itabashi Chuo Medical Center, Tokyo, Japan

Emi Anno,

• Hori, Keiichiro, Itabashi Chuo Medical Center, Tokyo, Japan

Keiichiro Hori,

• Hoshimoto, Ainori, Itabashi Chuo Medical Center, Tokyo, Japan

Ainori Hoshimoto,

• Harano, Makiko, Itabashi Chuo Medical Center, Tokyo, Japan

Makiko Harano,

• Hisada, Rina, Itabashi Chuo Medical Center, Tokyo, Japan

Rina Hisada,

• Hagiwara, So, Itabashi Chuo Medical Center, Tokyo, Japan

So Hagiwara,

• Tsukamoto, Yusuke, Itabashi Chuo Medical Center, Tokyo, Japan

Yusuke Tsukamoto,

Background

Patients on hemodialysis (HD) have a high incidence of sudden cardiac death. Since we often observed increasing incidence of arrhythmia during and just after dialysis session, drastic changes in electrolytes and/or acid-base may prolong QTc interval and cause arrhythmia. To investigate occurrence and frequency of arrhythmias chronologically and to examine the effects of electrolyte and acid base change on QTc interval during dialysis session.

Methods

We recorded ECG by 24-hour Holter and simultaneously measured changes in serum electrolytes and acid-base during a single hemodialysis session in 50 patients (F/M=15/35, 64% were diabetes, 1993 days of mean HD vintage, 70.1 years of mean age). HD parameters were: 3h (n=1), 3.5hr (n=1) or 4hr×3/week, dialyzer; polysulfone, QB=150-200ml/min. Concentration of electrolytes in dialysate were Na⁺ 140 mmol/l, K⁺ 2.0 mmol/l, Ca²⁺ 3.0 mmol/l, Mg²⁺ 1.0 mmol/l, Cl^- 110 mmol/l, CH₃COO^- 8 mmol/l and HCO₃^- 30 mmol/l.

Results

ECG was recorded from the start of dialysis session. The highest incidence of SVPC and VPC was recorded during 1^st 4-hour(during dialysis; 25%) and 2^nd 4-hour (right after dialysis; 26%). QTc did not increase in 18 patients and increase in 32 patients during dialysis session. Between these two groups, mean initial QTc was not different but logistic regression revealed that serum HCO₃^- (odds=0.64) and pH (odds=1.05E+009) were strong determinants among others (Ca²⁺, K⁺, Mg²⁺, Na⁺ and QTc). Multiple regression analysis revealed not only initial QTc but also QTc change during single dialysis session was affected by initial level or changes in serum Ca²⁺(p=0.0001/0.01), K⁺ (p=0.0007/0.03) and HCO₃^- (p=0.02)/pH(<0.0001) among others (Mg²⁺ and Na⁺ ) by weighted least squares multiple regression (r=0.83/0.85).

Conclusion

These results suggest that QTc prolongation during dialysis session is caused by not only magnitude of changes in serum Ca²⁺ and K⁺ as reported previously but also magnitude of alkalization in our dialysate composition. In order to prevent prolongation of QTc and arrhythmia, changes in acid-base should be minimized specifically.