QTc interval and QTc dispersion during haemodiafiltration

Floccari, Fulvio; Aloisi, Emanuele; Nostro, Lorena; Caccamo, Chiara; Crisafulli, Alessandra; Barillà, Antonio; Aloisi, Carmela; Romeo, Adolfo; Corica, Francesco; Ientile, Riccardo; Frisina, N; Buemi, Michele

doi:10.1111/j.1440-1797.2004.00333.x

Cited by 21 publications

(34 citation statements)

References 21 publications

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“…This phenomenon appears to have different causes, including dialysis-induced electrolyte alterations [16] . Several studies demonstrated how using a dialysis bath with a higher calcium concentration reduces the dispersion of QT and QTc intervals [20] . These intervals and their increased dispersions have been linked to the occurrence of arrhythmias in ESRD patients on HD [7,20] .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies demonstrated how using a dialysis bath with a higher calcium concentration reduces the dispersion of QT and QTc intervals [20] . These intervals and their increased dispersions have been linked to the occurrence of arrhythmias in ESRD patients on HD [7,20] . This effect could have various causes: regional differences in ventricular wall stress (mechanic-electric or contraction-excitation feedback) caused by ventricular dilation, fibrosis, and calcification, autonomic failure caused by uraemic autonomic neuropathy, decreased circulatory volume, rapid correction of metabolic acidosis, and rapid changes in serum K levels.…”

Section: Discussionmentioning

confidence: 99%

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Cardiac Vascular Calcification and QT Interval in ESRD Patients: Is There a Link?

Iorio

Bortone²,

Piscopo³

et al. 2006

Blood Purif

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We will present our experience and our preliminary data about the correlation between cardiac calcification and QT interval (and QT dispersion) in uraemia. We studied 32 haemodialysis (HD) patients (age 69 ± 16 years, time on dialysis 32 ± 27 months) and 12 chronic kidney disease stage 4 (CKD-4) patients (age 66 ± 17 years, uraemia duration 38 ± 16 months). The patients were characterized by a good mineral control, as shown by serum phosphate levels (3.6 ± 1.3 mg/dl in CKD-4 and 4.3 ± 1.6 mg/dl in HD patients) and Ca × P product (46 ± 17 and 49 ± 16 mg²/dl², respectively). The parathyroid hormone levels were higher in HD than CKD-4 patients (p < 0.0001). A TC score >400 was found to be highly prevalent in both groups. Significantly more HD patients (62.5%) showed cardiac calcification than CKD-4 patients (33%; p = 0.01). The patients were matched for TC scores higher or lower than 400. The two groups differed by gender (p < 0.05), age (p = 0.026), frequency of diabetes mellitus (p < 0.01), uraemia follow-up period (p < 0.001), low-density lipoprotein cholesterol level (p = 0.009), Ca × P product (p = 0.002), parathyroid hormone level (p < 0.0001), and corrected QT dispersion (p < 0.0001). The QT interval was higher in HD and CKD-4 patients with higher TC scores (approximately 11%), but QT interval dispersion was significantly higher in patients with TC scores >400. QT dispersion showed a linear correlation with TC scores in both groups (r = 0.899 and p < 0.0001 and r = 0.901 and p < 0.0001). Male gender, age, time (months) of uraemia, low-density lipoprotein cholesterol, albumin, calcium × phosphorus product, parathyroid hormone, and TC score are important determinants of QT dispersion. Our data show that it is possible to link dysrhythmias and cardiac calcification in uraemic patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cardiac Vascular Calcification and QT Interval in ESRD Patients: Is There a Link?

Iorio

Bortone²,

Piscopo³

et al. 2006

Blood Purif

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“…In some cases, and despite diet advice or medical therapy, patients arrive for their dialysis session with high serum K+ levels, and experience a sudden decrease during the early part of the session. This has been related to the appearance of arrhythmias or to the worsening of pre-existing arrhythmias: induction or worsening of ventricular extrasystoles, QT prolongation (Cupisti , 1999, , Floccari et al, 2004 and onset of paroxysmal atrial fibrillation have been described. Acetate Free Biofiltration with Potassium Profiled Dialysate (AFB-K) is a haemodialysis technique that attempts to obviate this problem, avoiding sudden potassium reductions during the haemodialysis session, but with due correction of the hyperkalaemia of the patients (Santoro et al, 2005).…”

Section: Arrhythmia In Patients On Dialysismentioning

confidence: 99%

Acetate Free Biofiltration with Potassium Profiled Dialysate (AFB-K)

Muñoz¹,

Gallardo²,

Montenegro³

2011

Technical Problems in Patients on Hemodialysis

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“…Bleyer et al [20] reporting on SD in 88 hemodialysis patients found that 13% had serum potassium below 3.5 mEq/l and 6 6.0 mEq/l on routine prior monthly laboratory values. Floccari et al [51] showed that an increase in QT dispersion -which is a risk factor for arrhythmias -during the first hour of HD when arrhythmias frequently occur, was inversely correlated with the rapid removal of potassium. Thus, avoiding rapid electrolyte shifts and dialysate very low in potassium is a sensible strategy to reduce the risk of cardiac arrest in hemodialysis centers but it is unlikely to eliminate the hazard [52] .…”

Section: Avoiding Low Potassium Dialysate and Rapid Electrolyte Shiftsmentioning

confidence: 99%

Sudden Death in Hemodialysis: An Update

Kanbay

Afsar²,

Goldsmith

et al. 2010

Blood Purif

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Cardiovascular disease including sudden death, myocardial infarction, cardiac arrest, malignant arrhythmias and other cardiac causes is the major cause of death accounting for 43% of all-cause mortality among hemodialysis patients. In addition to increased traditional risk factors, hemodialysis patients also have a number of nontraditional cardiovascular risk factors, which may play a prominent role in the development of sudden death such as left ventricular hypertrophy, coronary artery disease, rapid electrolyte shifts, QT dispersion, sympathetic overactivity, calcium-phosphate deposition. The purpose of the present review was to critically review the current literature to summarize the following aspects: (1) the pathophysiological mechanism responsible for sudden death in hemodialysis patients, and (2) the prevention and management of sudden death in hemodialysis patients.

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QTc interval and QTc dispersion during haemodiafiltration

Abstract: In conclusion, the decrease observed in the QTc interval at the end of an AFB session was inversely related to serum Ca++ concentrations. Moreover, an increase in QTc dispersion occurred during the first hour of the session, and was negatively correlated with serum K+.

Cited by 21 publications

References 21 publications

Cardiac Vascular Calcification and QT Interval in ESRD Patients: Is There a Link?

Cardiac Vascular Calcification and QT Interval in ESRD Patients: Is There a Link?

Acetate Free Biofiltration with Potassium Profiled Dialysate (AFB-K)

Sudden Death in Hemodialysis: An Update

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