Dialysate bath and QTc interval in patients on chronic maintenance hemodialysis: pilot study of single dialysis effects

B, Di Iorio; Torraca, Serena; Piscopo, Carmine; Ml, Sirico; L, Di Micco; Pota, Andrea; Tartaglia, Domenico; Berardino, L; Morrone, L F; Russo, Diana da Silva

doi:10.5301/jn.5000036

Cited by 61 publications

(54 citation statements)

References 33 publications

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“…37,38 Although the study was underpowered to detect differences in death outcomes, we found no difference between the groups regarding death, sudden death, cardiovascular death, and nonfatal cardiovascular events. Adverse events were more frequent (P=0.04), and serious adverse events tended to be higher (P=0.08) in the 1.75 Ca group, mainly because of hypercalcemia requiring permanent discontinuation.…”

Section: Discussionmentioning

confidence: 65%

Reduction of Dialysate Calcium Level Reduces Progression of Coronary Artery Calcification and Improves Low Bone Turnover in Patients on Hemodialysis

Ok¹,

Aşçı²,

Bayraktaroğlu

et al. 2015

JASN

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Exposure to high Ca concentrations may influence the development of low-turnover bone disease and coronary artery calcification (CAC) in patients on hemodialysis (HD). In this randomized, controlled study, we investigated the effects of lowering dialysate Ca level on progression of CAC and histologic bone abnormalities in patients on HD. Patients on HD with intact parathyroid hormone levels #300 pg/ml receiving dialysate containing 1.75 or 1.50 mmol/L Ca (n=425) were randomized to the 1.25-mmol/L Ca (1.25 Ca; n=212) or the 1.75-mmol/L Ca (1.75 Ca; n=213) dialysate arm. Primary outcome was a change in CAC score measured by multislice computerized tomography; main secondary outcome was a change in bone histomorphometric parameters determined by analysis of bone biopsy specimens. CAC scores increased from 4526869 (mean6SD) in the 1.25 Ca group and 5006909 in the 1.75 Ca group (P=0.68) at baseline to 61661086 and 80361412, respectively, at 24 months (P=0.25). Progression rate was significantly lower in the 1.25 Ca group than in the 1.75 Ca group (P=0.03). The prevalence of histologically diagnosed low bone turnover decreased from 85.0% to 41.8% in the 1.25 Ca group (P=0.001) and did not change in the 1.75 Ca group. At 24 months, bone formation rate, trabecular thickness, and bone volume were higher in the 1.25 Ca group than in the 1.75 Ca group. Thus, lowering dialysate Ca levels slowed the progression of CAC and improved bone turnover in patients on HD with baseline intact parathyroid hormone levels #300 pg/ml.

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Section: Discussionmentioning

confidence: 65%

Reduction of Dialysate Calcium Level Reduces Progression of Coronary Artery Calcification and Improves Low Bone Turnover in Patients on Hemodialysis

Ok¹,

Aşçı²,

Bayraktaroğlu

et al. 2015

JASN

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“…21 Genovesi et al, 22 utilizando dialisatos com diferentes concentrações de cálcio (K + de 2 e 3 mmol/L; Ca 2+ de 1,25 ou 1,5 ou 1,75 mmol/L), observaram QTc > 440 ms em 56% dos pacientes cujo dialisato continha as mais baixas concentrações de cálcio e de potássio e em apenas 18% dos pacientes em que foi prescrito dialisato com as concentrações mais elevadas desses íons. Resultados semelhantes foram encontrados por Di Iorio et al, 23 em que o intervalo QTc foi mais prolongado de modo significativo em pacientes cujo dialisato continha as mais baixas concentrações de cálcio e potássio e as mais altas concentrações de bicarbonato. Em um estudo que envolveu pacientes com DRC estágio 4 e estágio 5 em hemodiálise, Di Iorio et al 24 demonstraram que a calcificação cardíaca, medida pelo score de cálcio em tomografia computadorizada (TC score), mostrou--se um determinante independente do intervalo QT, apresentando uma relação linear e positiva, de modo que quanto maior o TC score, maior foi a dispersão do intervalo QT.…”

Section: Discussionunclassified

Electrocardiographic findings in chronic hemodialysis patients

Bignotto¹,

Kallás²,

Djouki³

et al. 2012

Jornal Brasileiro De Nefrologia

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“…Mechanistically, high-bicarbonate dialysate/prescription has been shown to have effects on the QT interval [12,13], hemodynamics [14][15][16], levels of serum potassium [17], and ionized calcium [18], which may increase the risk for ventricular arrhythmia [19][20][21]. Studies have linked changes in ionized calcium to high bicarbonate dialysate prescription [18,22], but we only had data on total calcium, and hence could not study the effects on ionized calcium, while other studies have found results similar to ours [23,24].…”

Section: Discussionmentioning

confidence: 99%

Effect of Bicarbonate-Buffered Dialysate on Ventricular Arrhythmias in Hemodialysis Patients

et al. 2019

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Background: The etiology of sudden cardiac death in patients with end-stage renal disease (ESRD) on hemodialysis (HD) is largely unknown, though there is evidence to suggest that metabolic alkalosis induced by HD with a high-bicarbonate dialysate/prescription may play a role. Methods: We investigated the effects of metabolic alkalosis induced by HD with an acetate-containing bicarbonate-buffered dialysate on frequency of ventricular arrhythmia in 47 patients with ESRD on chronic HD using 48-h Holter monitoring in 3 phases: intra-HD, post-HD day 1, and post-HD day 2. Serum levels of bicarbonate, calcium, and potassium along with hemodynamics were measured pre-HD, post-HD, 20-h post-HD, and 44-h post-HD. Correlations were performed to verify the association between bicarbonate prescription and change in serum bicarbonate levels post-HD and to determine if the HD-induced change in serum bicarbonate level (metabolic alkalosis) had any direct association with ambient ventricular arrhythmia (premature ventricular contractions per hour) or indirect associations with ambient ventricular arrhythmia by affecting electrolytes or hemodynamics that are known to increase the risk of ventricular arrhythmia. Results: Mean pre-HD serum bicarbonate level was 21.3 mEq/L. Dialysate bicarbonate prescription (mean of 36.4 mEq/L) correlated with changes in serum bicarbonate levels immediately post-HD 26.7 mEq/L (r = 0.46, p < 0.01), 20-h post-HD 25.2 mEq/L (r = 0.38), and 44-h post-HD 23.2 mEq/L (r = 0.35, p = 0.01). No statistically significant correlations were found between the post-HD change in serum bicarbonate levels (metabolic alkalosis) with ambient ventricular arrhythmia, changes in serum calcium, potassium, or hemodynamics in any phase. Conclusions: High-bicarbonate dialysate prescription is associated with metabolic alkalosis following the HD procedure. A mild metabolic alkalosis induced by HD with an acetate-containing bicarbonate-buffered dialysate solution had no direct association with ambient ventricular arrhythmia on Holter monitoring and was not associated with changes in hemodynamics or changes in serum total calcium or potassium levels. This study helps to provide guidance for the safe use of high bicarbonate dialysate/prescription in patients with ESRD on HD.

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Dialysate bath and QTc interval in patients on chronic maintenance hemodialysis: pilot study of single dialysis effects

Abstract: The present pilot study shows that changes in QTc interval during hemodialysis depend on both electrolyte and bicarbonate concentrations in dialysate.

Cited by 61 publications

References 33 publications

Reduction of Dialysate Calcium Level Reduces Progression of Coronary Artery Calcification and Improves Low Bone Turnover in Patients on Hemodialysis

Reduction of Dialysate Calcium Level Reduces Progression of Coronary Artery Calcification and Improves Low Bone Turnover in Patients on Hemodialysis

Electrocardiographic findings in chronic hemodialysis patients

Effect of Bicarbonate-Buffered Dialysate on Ventricular Arrhythmias in Hemodialysis Patients

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