Patients with complex arrhythmias during and after haemodialysis suffer from different regimens of potassium removal

Antonio Santoro, Elena Mancini, Gerad London, Lucile Mercadal, Hafedh Fessy, Bruno Perrone, Leonardo Cagnoli, Eleonora Grandi, Stefano Severi, Silvio Cavalcanti

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Background. Although sudden death is one of the most frequent causes of death in haemodialysis (HD) patients, the problem of cardiac arrhythmias, the major cause of these outcomes, has been little discussed. Methods. In 30 arrhythmia-prone HD patients, we compared the arrhythmogenic effects of two dialysis techniques differing in dialysate potassium (K) content. Each patient underwent Acetate-Free Biofiltration sessions with constant (2.5 mEq/l) K (AFB) and sessions with decreasing intra-HD K (AFBK), according to a crossover single blind design. Holter ECG recording and plasma electrolyte measurements were performed during each dialysis session. Results. There was a tendency in the whole sample for arrhythmia appearance in AFBK to be reduced as compared to AFB throughout the 24 hr period, although this reduction was not statistically significant. In the subset of patients sensitive to dialysis as far as arrhythmia onset is concerned, AFBK was systematically less arrhythmogenic than AFB (P < 0.01). The highest difference was achieved around the 14th hour after the end of dialysis, when the premature ventricular contractions in AFB were 3.9 times higher than in AFBK (P < 0.05). Potassium kinetics differed between the two procedures. At the first hour of treatment, the plasma K concentration was lower in AFB than in AFBK (3.67 ± 0.15 mEq/l in AFB vs 4.06 ± 0.13 mEq/l in AFBK, P = 0.05). Conclusions. Our study shows a greater arrhythmogenic activity with the use of a constant and relatively low K concentration as compared to decreasing K profiling in dialysis-sensitive arrhythmic patients. Smoother K removal may well engender a kind of protective effect.

Original languageEnglish (US)
Pages (from-to)1415-1421
Number of pages7
JournalNephrology Dialysis Transplantation
Volume23
Issue number4
DOIs
StatePublished - Apr 1 2008
Externally publishedYes

Fingerprint

Renal Dialysis
Cardiac Arrhythmias
Dialysis
Potassium
Hemodiafiltration
Ventricular Premature Complexes
Dialysis Solutions
Sudden Death
Electrolytes
Cause of Death
Electrocardiography
Therapeutics

Keywords

  • Chronic haemodialysis
  • Electrolytes
  • Electrophysiology
  • Heart disease
  • Hypokalemia

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Santoro, A., Mancini, E., London, G., Mercadal, L., Fessy, H., Perrone, B., ... Cavalcanti, S. (2008). Patients with complex arrhythmias during and after haemodialysis suffer from different regimens of potassium removal. Nephrology Dialysis Transplantation, 23(4), 1415-1421. https://doi.org/10.1093/ndt/gfm730

Patients with complex arrhythmias during and after haemodialysis suffer from different regimens of potassium removal. / Santoro, Antonio; Mancini, Elena; London, Gerad; Mercadal, Lucile; Fessy, Hafedh; Perrone, Bruno; Cagnoli, Leonardo; Grandi, Eleonora; Severi, Stefano; Cavalcanti, Silvio.

In: Nephrology Dialysis Transplantation, Vol. 23, No. 4, 01.04.2008, p. 1415-1421.

Research output: Contribution to journalArticle

Santoro, A, Mancini, E, London, G, Mercadal, L, Fessy, H, Perrone, B, Cagnoli, L, Grandi, E, Severi, S & Cavalcanti, S 2008, 'Patients with complex arrhythmias during and after haemodialysis suffer from different regimens of potassium removal', Nephrology Dialysis Transplantation, vol. 23, no. 4, pp. 1415-1421. https://doi.org/10.1093/ndt/gfm730
Santoro, Antonio ; Mancini, Elena ; London, Gerad ; Mercadal, Lucile ; Fessy, Hafedh ; Perrone, Bruno ; Cagnoli, Leonardo ; Grandi, Eleonora ; Severi, Stefano ; Cavalcanti, Silvio. / Patients with complex arrhythmias during and after haemodialysis suffer from different regimens of potassium removal. In: Nephrology Dialysis Transplantation. 2008 ; Vol. 23, No. 4. pp. 1415-1421.
@article{11fa41e2d8834fb29d1fb3fbdf5e915c,
title = "Patients with complex arrhythmias during and after haemodialysis suffer from different regimens of potassium removal",
abstract = "Background. Although sudden death is one of the most frequent causes of death in haemodialysis (HD) patients, the problem of cardiac arrhythmias, the major cause of these outcomes, has been little discussed. Methods. In 30 arrhythmia-prone HD patients, we compared the arrhythmogenic effects of two dialysis techniques differing in dialysate potassium (K) content. Each patient underwent Acetate-Free Biofiltration sessions with constant (2.5 mEq/l) K (AFB) and sessions with decreasing intra-HD K (AFBK), according to a crossover single blind design. Holter ECG recording and plasma electrolyte measurements were performed during each dialysis session. Results. There was a tendency in the whole sample for arrhythmia appearance in AFBK to be reduced as compared to AFB throughout the 24 hr period, although this reduction was not statistically significant. In the subset of patients sensitive to dialysis as far as arrhythmia onset is concerned, AFBK was systematically less arrhythmogenic than AFB (P < 0.01). The highest difference was achieved around the 14th hour after the end of dialysis, when the premature ventricular contractions in AFB were 3.9 times higher than in AFBK (P < 0.05). Potassium kinetics differed between the two procedures. At the first hour of treatment, the plasma K concentration was lower in AFB than in AFBK (3.67 ± 0.15 mEq/l in AFB vs 4.06 ± 0.13 mEq/l in AFBK, P = 0.05). Conclusions. Our study shows a greater arrhythmogenic activity with the use of a constant and relatively low K concentration as compared to decreasing K profiling in dialysis-sensitive arrhythmic patients. Smoother K removal may well engender a kind of protective effect.",
keywords = "Chronic haemodialysis, Electrolytes, Electrophysiology, Heart disease, Hypokalemia",
author = "Antonio Santoro and Elena Mancini and Gerad London and Lucile Mercadal and Hafedh Fessy and Bruno Perrone and Leonardo Cagnoli and Eleonora Grandi and Stefano Severi and Silvio Cavalcanti",
year = "2008",
month = "4",
day = "1",
doi = "10.1093/ndt/gfm730",
language = "English (US)",
volume = "23",
pages = "1415--1421",
journal = "Nephrology Dialysis Transplantation",
issn = "0931-0509",
publisher = "Oxford University Press",
number = "4",

}

TY - JOUR

T1 - Patients with complex arrhythmias during and after haemodialysis suffer from different regimens of potassium removal

AU - Santoro, Antonio

AU - Mancini, Elena

AU - London, Gerad

AU - Mercadal, Lucile

AU - Fessy, Hafedh

AU - Perrone, Bruno

AU - Cagnoli, Leonardo

AU - Grandi, Eleonora

AU - Severi, Stefano

AU - Cavalcanti, Silvio

PY - 2008/4/1

Y1 - 2008/4/1

N2 - Background. Although sudden death is one of the most frequent causes of death in haemodialysis (HD) patients, the problem of cardiac arrhythmias, the major cause of these outcomes, has been little discussed. Methods. In 30 arrhythmia-prone HD patients, we compared the arrhythmogenic effects of two dialysis techniques differing in dialysate potassium (K) content. Each patient underwent Acetate-Free Biofiltration sessions with constant (2.5 mEq/l) K (AFB) and sessions with decreasing intra-HD K (AFBK), according to a crossover single blind design. Holter ECG recording and plasma electrolyte measurements were performed during each dialysis session. Results. There was a tendency in the whole sample for arrhythmia appearance in AFBK to be reduced as compared to AFB throughout the 24 hr period, although this reduction was not statistically significant. In the subset of patients sensitive to dialysis as far as arrhythmia onset is concerned, AFBK was systematically less arrhythmogenic than AFB (P < 0.01). The highest difference was achieved around the 14th hour after the end of dialysis, when the premature ventricular contractions in AFB were 3.9 times higher than in AFBK (P < 0.05). Potassium kinetics differed between the two procedures. At the first hour of treatment, the plasma K concentration was lower in AFB than in AFBK (3.67 ± 0.15 mEq/l in AFB vs 4.06 ± 0.13 mEq/l in AFBK, P = 0.05). Conclusions. Our study shows a greater arrhythmogenic activity with the use of a constant and relatively low K concentration as compared to decreasing K profiling in dialysis-sensitive arrhythmic patients. Smoother K removal may well engender a kind of protective effect.

AB - Background. Although sudden death is one of the most frequent causes of death in haemodialysis (HD) patients, the problem of cardiac arrhythmias, the major cause of these outcomes, has been little discussed. Methods. In 30 arrhythmia-prone HD patients, we compared the arrhythmogenic effects of two dialysis techniques differing in dialysate potassium (K) content. Each patient underwent Acetate-Free Biofiltration sessions with constant (2.5 mEq/l) K (AFB) and sessions with decreasing intra-HD K (AFBK), according to a crossover single blind design. Holter ECG recording and plasma electrolyte measurements were performed during each dialysis session. Results. There was a tendency in the whole sample for arrhythmia appearance in AFBK to be reduced as compared to AFB throughout the 24 hr period, although this reduction was not statistically significant. In the subset of patients sensitive to dialysis as far as arrhythmia onset is concerned, AFBK was systematically less arrhythmogenic than AFB (P < 0.01). The highest difference was achieved around the 14th hour after the end of dialysis, when the premature ventricular contractions in AFB were 3.9 times higher than in AFBK (P < 0.05). Potassium kinetics differed between the two procedures. At the first hour of treatment, the plasma K concentration was lower in AFB than in AFBK (3.67 ± 0.15 mEq/l in AFB vs 4.06 ± 0.13 mEq/l in AFBK, P = 0.05). Conclusions. Our study shows a greater arrhythmogenic activity with the use of a constant and relatively low K concentration as compared to decreasing K profiling in dialysis-sensitive arrhythmic patients. Smoother K removal may well engender a kind of protective effect.

KW - Chronic haemodialysis

KW - Electrolytes

KW - Electrophysiology

KW - Heart disease

KW - Hypokalemia

UR - http://www.scopus.com/inward/record.url?scp=42949179134&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=42949179134&partnerID=8YFLogxK

U2 - 10.1093/ndt/gfm730

DO - 10.1093/ndt/gfm730

M3 - Article

C2 - 18065796

AN - SCOPUS:42949179134

VL - 23

SP - 1415

EP - 1421

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

IS - 4

ER -