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Kidney Week

Abstract: FR-PO406

Arrhythmia in Chronic Hemodialysis as a Function of Pre-Dialysis Electrolytes and Interdialytic Interval

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Mosman, Amy, St. Louis University, St. Louis, Missouri, United States
  • Lee, Taewoo, Saint Louis Univeristy School of Medicine, Saint Louis, Missouri, United States
  • Edwards, John C., St. Louis University, St. Louis, Missouri, United States

Group or Team Name

  • The SLU Arrhythmia in Hemodialysis Study Investigators
Background

Sudden cardiac death is a leading cause of death in hemodialysis patients. For patients on thrice weekly dialysis, these deaths are most common before and during dialysis following the three day interdialytic period. Cummulative fluid, electrolyte, and metabolite accumulation during the longer interdialytic period have been correlated with increased arrhythmia, but the specific imbalances that are driving this cardiac instability have not been identified.

Methods

60 stable patients on chronic thrice weekly hemodialysis with a tendency to hyperkalemia provided informed consent. Cardiac rhythm was continuously monitored for one week starting at the midweek dialysis session (day 1). Pre-dialysis chemistries and 12 lead EKG were determined at the pre and post weekend dialysis session (days 3 and 6). Frequency of ventricular ectopy, superventricular ectopy, bradycardia, and average QTc were reported in 4 hour blocks. Rates of arrhythmias through the week and correlation with individual clinical parameters were analyzed using standard statistical methods.

Results

Total arrhythmia frequency was low and did not correlate with dialysis in the whole population. Neither ventricular ectopy nor bradycardia correlated with dialysis or interdialytic interval. Superventricular ectopy showed peaks during dialysis on both days 3 and 6, but these did not reach statistical significance. None of the arrhythmias correlated with pre-dialysis electrolytes, BNP or ultrafiltration volumes. Pre-dialysis PR intervals, QRS duration, and QTc did not correlate with arrythmias or with electrolytes. QTc, one known risk factor for ventricular arrhythmia, was significantly prolonged during dialysis on both days 3 and 6: ΔQTc pre- to intra-dialysis 18.6 ± 38.9 ms (P=0.0007) and 13.6 ± 53.6 (P=0.031) on days 3 and 6, respectively. Patients with lower pre dialysis serum Ca were more likely to prolong QTc during dialysis.

Conclusion

In this cohort of 60 stable chronic hemodialysis patients, there was significant prolongation of the QTc during each dialysis session which was more prominent in patient with lower pre-dialysis serum Ca. However, prolonged QTc was not correlated with observed arrhythmia and we did not find a significant increase in arrhythmia related to pre-dialysis electrolytes or intradialytic period.

Funding

  • Commercial Support