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Abstract: PO1228

The Effect of Intradialytic Potassium and Magnesium Fluctuations on Cardiovascular Functioning in ESRD Patients Undergoing In-Center Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Chuu, Andy, Washington University in Saint Louis, Saint Louis, Missouri, United States
  • Matzumura Umemoto, Gonzalo, Washington University in Saint Louis, Saint Louis, Missouri, United States
  • Rauchman, Michael I., Saint Louis VA Medical Center John Cochran Division, Saint Louis, Missouri, United States
  • O Brien, Frank J., Washington University in Saint Louis, Saint Louis, Missouri, United States
Background

Patients with ESRD receiving in-center hemodialysis (HD) have an age-adjusted rate of mortality 4 times the general population. Increased mortality has been attributed to fatal arrhythmias. Mechanisms and risk factors for this are unknown. It has been postulated that changes in serum levels of Potassium(K)/Magnesium(Mg) with HD contribute to arrhythmia generation. Limited data is available to guide personalization of K prescription of HD to reduce this risk. No data exists describing the serum changes in Mg pre-, intra-, and post-HD. We examine the correlation between electrolyte fluctuations, arrhythmia generation, and heart rate variability (HRV) in ESRD patients undergoing in-center HD.

Methods

Single center, prospective, cross-sectional pilot study. 25 patients enrolled to achieve an 80% power. Demographic data, dialysis vintage, and HD prescription were recorded. Arrhythmia data was collected by placement of Holter monitor prior to 1st weekly HD session and recorded continuously for 5 days ending at completion of 3rd weekly HD session. Serum samples were obtained at time intervals 30, 60, 90, and 120 minutes during 1st weekly HD session for electrolytes. Pre and Post HD serum electrolyte analysis occurred during all 3 treatments. Associations were examined by count regression utilizing Poisson or negative binomial methods.

Results

25 patients were included in data analysis. Mean age 63 and primarily African American (73%). 73% of individuals were dialyzed utilizing 2mmol/L. Ectopy data and serum potassium / magnesium data are summarized in Table 1.

Conclusion

There is a trend towards increased ectopy (particularly on HD day 1) and decreased HRV on HD days. There is a trend towards hypo-K post-HD after HD sessions 2 and 3. Serum Mg levels remained stable pre and post HD throughout all HD sessions. Data derived in this study will be utilized to guide a larger future study with the goal towards personalized HD treatments.

Results
 # Hypokalemia (n)Mean Pre K (mmol/L)(std)Mean Post K (mmol/L)(std)Mean Pre Mg (mmol/L)(std)Mean Post Mg (mmol/L)(std)
HD Session 174.7 (0.6)3.4 (0.3)2.3 (0.3)1.9 (0.2)
HD Session 2104.7 (0.4)3.3 (0.3)2.3 (0.2)1.9 (0.2)
HD Session 3104.7 (0.5)3.4 (0.3)2.3 (0.2)1.9 (0.2)
      
   HD Session 1Interdialytic DaysHD Session 2 & 3 (mean)
Mean Daily Ectopic Beats  578123463630