Associates of Cardiopulmonary Arrest in the Perihemodialytic Period

Abstract

Cardiopulmonary arrest during and proximate to hemodialysis is rare but highly fatal. Studies have examined peridialytic sudden cardiac event risk factors, but no study has considered associates of cardiopulmonary arrests (fatal and nonfatal events including cardiac and respiratory causes). This study was designed to elucidate patient and procedural factors associated with peridialytic cardiopulmonary arrest. Data for this case-control study were taken from the hemodialysis population at Fresenius Medical Care, North America. 924 in-center cardiopulmonary events (cases) and 75,538 controls were identified. Cases and controls were 1 : 5 matched on age, sex, race, and diabetes. Predictors of cardiopulmonary arrest were considered for logistic model inclusion. Missed treatments due to hospitalization, lower body mass, coronary artery disease, heart failure, lower albumin and hemoglobin, lower dialysate potassium, higher serum calcium, greater erythropoietin stimulating agent dose, and normalized protein catabolic rate (J-shaped) were associated with peridialytic cardiopulmonary arrest. Of these, lower albumin, hemoglobin, and body mass index; higher erythropoietin stimulating agent dose; and greater missed sessions had the strongest associations with outcome. Patient health markers and procedural factors are associated with peridialytic cardiopulmonary arrest. In addition to optimizing nutritional status, it may be prudent to limit exposure to low dialysate potassium (<2 K bath) and to use the lowest effective erythropoietin stimulating agent dose.

Changes in Serum Bicarbonate Levels Caused by Acetate‐Containing Bicarbonate‐Buffered Hemodialysis Solution: An Observational Prospective Cohort Study

“…Thus, in routine clinical practice, maintaining pre‐dialysis serum bicarbonate levels >22 mEq/L without consideration of nutritional status may contribute to adverse cardiovascular outcomes since a low serum bicarbonate level may reflect higher protein intake and prolong survival. A recent study measuring cardiopulmonary arrest in the perihemodialytic period found that there was a strong association of low serum albumin, hemoglobin and BMI, higher erythropoietin dosing, and greater missed sessions with peri‐dialytic cardiopulmonary arrest . We measured protein intake indirectly by measuring protein catabolic rate (PCR) without correcting for residual renal function since the data was not available in our study population.…”

Dialysis Prescription and Sudden Death

“…Among 76,462 hemodialysis patients from a national LDO, dialysate concentrations categorized as <2.3, 2.3–2.5, and >2.5 meq/L were not associated with cardiopulmonary arrest. 27 Similarly, a secondary analysis of 3883 hemodialysis patients from the EVOLVE trial did not observe an association between dialysate calcium concentrations (categorized as <2.5, 2.5, vs. ≥2.5 meq/L) nor the primary composite endpoint (death or first non-fatal myocardial infarction, hospitalization for unstable angina, heart failure or peripheral vascular event), cardiovascular death, nor SCD. 43 There was also no difference in the impact of cinacalcet upon outcomes by the dialysate calcium concentration nor serum-to-dialysate calcium gradient.…”

“…12 A subsequent study of 37,765 hemodialysis patients across 12 countries from the DOPPS cohort indicated that dialysate potassium concentrations of ≤1.5 meq/L and 2–2.5 meq/L were associated with higher SCD risk compared to concentrations ≥3.0 meq/L, 8 while a case-control analysis of 924 cases and 75,538 control patients from a US national LDO found that dialysate potassium concentrations of 1.0 meq/L were linked with higher risk of peridialytic cardiopulmonary arrest. 27…”

“…However, a subsequent study of 76,462 US hemodialysis patients from an LDO which examined “total dialysate buffer” levels (bicarbonate + acetate) categorized as <41, 41–45 (reference) vs. >45 meq/L did not show associations with peridialytic cardiopulmonary arrest. 27 While optimal dialysate bicarbonate prescribing practices require further study, we recommend titration of dialysate bicarbonate concentrations to a target of serum bicarbonate levels >24 mEq/L and avoidance of the “total buffer” calculation as wrong and misleading.…”

Assistência de enfermagem nas complicações durante as sessões de hemodiálise

“…Também não foram relatados casos de parada cardiorrespiratória. Um estudo americano demonstrou que o risco de parada cardíaca no período peri-dialítico é maior entre pacientes com doença coronariana, insuficiência cardíaca, níveis baixos de potássio no dialisato, elevado cálcio sérico, hipoalbuminemia, baixo peso, baixa hemoglobina [26].…”