Mechanism and prevention of cardiac arrhythmias in chronic hemodialysis patients

Abstract

We monitored, by the Holter method, 23 clinically stable maintenance hemodialysis patients for 5 +/- (SEM) 2 hours before hemodialysis, 5.0 +/- 0.5 hours during hemodialysis, and 13 +/- 3 hours after hemodialysis. Of 23 patients, 9 (39%) had unexpected frequent or complex ventricular arrhythmias recorded and after hemodialysis with a potassium dialysate bath concentration of 2.0 mEq/liter. Patients with ventricular arrhythmias were more likely to be using digoxin (8/9 vs. 1/4) and to have evidence of left ventricular hypertrophy (9/9 vs. 7/4 than were those patients without arrhythmias. Of these 9 patients with arrhythmias, 6 underwent repeat Holter monitoring during multiple dialysate protocols. Of the 6 patients, 4 had a significant reduction in the frequency of ventricular ectopy when a dialysate of 3.5 mEq/liter potassium was used (P < 0.05), but of these 6, 3 still had complex arrhythmias. The use, however, of a 3.5 mEq/liter potassium dialysate plus the administration of a 400-mg dose of quinidine sulfate orally 45 min prior to hemodialysis was successful in reducing ventricular ectopic frequency and complexity in all the patients studied. Conclusion. Maintenance hemodialysis patient using digoxin and with left ventricular hypertrophy have an unexpectdly high indicence of occult, potentoial serious, ventricular arrhythmias during and after hemodialysis, revealed by Holter monitoring. There is preliminary evidence that a low-potassium bath concentration may play a role in predisoposing patients to these arrhythmias. Further prospective studies with largaer number of patients will be needed, however, to evaluate the significance of these findings.

Digoxin Associates with Mortality in ESRD

“…The narrow therapeutic index and proarrhythmic qualities of the drug 24 have the potential to limit the overall effectiveness of digoxin in the ESRD population. 1,4 Patients who are on long-term RRT are subject to recurrent fluid/electrolyte shifts, hypoalbuminuria, and end-organ damage, which may predispose patients with ESRD to adverse reactions from digoxin.…”

Electrical storm in hemodialysis: A story of death reversed 65 times

“…After a 4-year follow-up, the patients with premature ventricular beats did not have a higher mortality rate than the patients without them. 4 Intradialysis electrolyte shifts seem to play a role in the origin of ventricular arrhythmias: 39% of the 23 patients monitored by Morrison et al 5 had frequent or complex ventricular arrhythmias during and after HD with a dialysate bath whose potassium concentration was 2.0 mEq/L. Ventricular arrhythmias were common, especially in patients on digoxin or with left ventricular hypertrophy; some of these patients were reported to have experienced a significantly reduced frequency of ventricular ectopy when a dialysate containing potassium at 3.5 mEq/L was used.…”

The Comparison of Four Different Dialysates on QT Dispersion and Arrhythmias in Hemodialysis Patients

“…The course of various laboratory parameters in predialysis and postdialysis periods in patients dialyzed by various dialysates are provided in (1)(2). Although the mechanisms responsible for the increased risk of SCD could be attributed to electrolyte imbalance or malignant arrhythmias in hemodialysis (HD) patients (3), the whole scenario is not clear because of complex characteristics of ventricular myocardium physiology.…”