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Abstract: TH-PO266

The Association of Dialysate Bicarbonate with Cardiac Arrhythmia in the Monitoring in Dialysis (MiD) Study

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ravi, Katherine Scovner, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Tumlin, James A., NephroNet Clinical Research Consortium, Atlanta, Georgia, United States
  • Roy-Chaudhury, Prabir, UNC Kidney Center, Chapel Hill, NC and WG (Bill) Hefner VA Medical Center, Salisbury, North Carolina, United States
  • Charytan, David M., New York University School of Medicine and NYU Langone Medical Center, New York, New York, United States
  • McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States

Group or Team Name

  • Monitoring in Dialysis Study Group.
Background

Sudden death accounts for half of all cardiovascular-related mortality among patients receiving maintenance hemodialysis (HD) and occurs more frequently on days that patients undergo HD. Higher dialysate bicarbonate (DBIC) may predispose to alkalemia and arrhythmogenesis. We tested if higher DBIC is associated with cardiac arrhythmia, and if this is modified by serum bicarbonate (SBIC).

Methods

Using data from the Monitoring in Dialysis study, we analyzed session-level data over a 12-month period from 66 patients with implantable loop recorders (ILR). We fit logistic regression and negative binomial mixed effects regression models to assess the association of DBIC with the presence and frequency of reviewer confirmed arrhythmia (RCA) events (ILR identified or patient marked event in which a manual review of the stored ECG tracing confirmed the presence of atrial fibrillation, supraventricular tachycardia, sinus tachycardia with rate >130 beats per minute, ventricular tachycardia, asystole, or bradycardia) in the intra- and inter-dialytic period.

Results

Mean age was 56 ± 12 years, 70% were male, 53% were Black, and 35% were Asian. There were 9,718 RCA events over 3,655 HD sessions. There were fewer RCA episodes associated with DBIC >35 compared to 35 mEq/L in unadjusted and adjusted models (IRR 0.45 (0.27, 0.75) and aIRR 0.54 (0.30, 0.97), respectively). Otherwise no associations between DBIC and arrhythmia were identified. No results were modified by the inclusion of SBIC in the model.

Conclusion

We observed a lower frequency of RCA with higher DBIC, contrary to our original hypothesis. Within RCA, a majority of events were atrial arrhythmia. Validation of these findings in larger studies is required, with further need for interventional studies to explore the optimal DBIC level.

Funding

  • NIDDK Support