Calcium Profiling in Hemodiafiltration: A New Way to Reduce the Calcium Overload Risk without Compromising Cardiovascular Stability

Severi, Stefano; Bolasco, Piergiorgio; Badiali, Fabio; Concas, Gabriella; Mancini, Elena; Summa, Aurora; Perazzini, Claudia; Steckiph, Denis; Cagnoli, L; Santoro, Antonio

doi:10.5301/ijao.5000320

Cited by 14 publications

(8 citation statements)

References 31 publications

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“…Profiling of dialysate calcium also has been proposed to improve cardiovascular stability. 24 However, it is important to highlight that although technologically feasible, currently there are no automated systems built into the dialysis machines, and this will require manually setting up the system, which limits its practicality.…”

Section: Profiling Potassium Plasma/dialysate Gradient To Reduce the mentioning

confidence: 99%

Dialysate and Serum Potassium in Hemodialysis

Hung

Hakim

2015

American Journal of Kidney Diseases

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Section: Profiling Potassium Plasma/dialysate Gradient To Reduce the mentioning

confidence: 99%

Dialysate and Serum Potassium in Hemodialysis

Hung

Hakim

2015

American Journal of Kidney Diseases

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“…Patients were enrolled from Malpighi Hospital in Bologna (41 patients) and Infermi Hospital in Rimini (4 patients) within a previous study on haemodialysis therapy 28 ; approval of the Institutional Review Board (IRB) Ethics Committee was not required. All the procedures were in accordance with the Helsinki Declaration.…”

Section: Methodsmentioning

confidence: 99%

Noninvasive quantification of blood potassium concentration from ECG in hemodialysis patients

Corsi

Cortesi

Callisesi

et al. 2017

Sci Rep

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Blood potassium concentration ([K+]) influences the electrocardiogram (ECG), particularly T-wave morphology. We developed a new method to quantify [K+] from T-wave analysis and tested its clinical applicability on data from dialysis patients, in whom [K+] varies significantly during the therapy. To elucidate the mechanism linking [K+] and T-wave, we also analysed data from long QT syndrome type 2 (LQT2) patients, testing the hypothesis that our method would have underestimated [K+] in these patients. Moreover, a computational model was used to explore the physiological processes underlying our estimator at the cellular level. We analysed 12-lead ECGs from 45 haemodialysis and 12 LQT2 patients. T-wave amplitude and downslope were calculated from the first two eigenleads. The T-wave slope-to-amplitude ratio (TS/A) was used as starting point for an ECG-based [K+] estimate (KECG). Leave-one-out cross-validation was performed. Agreement between KECG and reference [K+] from blood samples was promising (error: −0.09 ± 0.59 mM, absolute error: 0.46 ± 0.39 mM). The analysis on LQT2 patients, also supported by the outcome of computational analysis, reinforces our interpretation that, at the cellular level, delayed-rectifier potassium current is a main contributor of KECG correlation to blood [K+]. Following a comprehensive validation, this method could be effectively applied to monitor patients at risk for hyper/hypokalemia.

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“…A continuous QTc monitoring during acetate-free biofiltration with hemodiafiltration (HDF) session with different dCa (1.25 mM/l, 2 mM/L and profiled Ca) showed increased QTc for the lower dCa 17 . Floccari et al performed a hourly ECG during three acetate-free HDF sessions with dCa of 1.75 mmol/l which showed a negative correlation of QTc with serum Ca levels at the end 4 .…”

Section: Introductionmentioning

confidence: 99%

Effect of citric-acid dialysate on the QTC-interval

Meulen

Hermans

Sande

et al. 2021

Sci Rep

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Lower dialysate calcium (dCa) concentration and dialysate citric-acidification may positively affect calcification propensity in serum of haemodialysis (HD) patients. However, the accompanying lower ionized blood calcium concentration may lead to a prolonged cardiac action potential, which is possibly pro-arrhythmic. The aim of this study is to investigate the influence of citric-acid dialysate on the QT-interval corrected for heart rate (QTc) compared to conventional dialysate with different dCa concentrations. We conducted a four-week multicentre, randomized cross-over trial. In week one and three patients received acetic-acid dialysate with a dCa of 1.50 mmol/l (A1.5), in week two and four acetic-acid dialysate with a dCa of 1.25 mmol/l (A1.25) or citric-acid dialysate (1.0 mmol/l) with a dCa of 1.50 mmol/l (C1.5) depending on randomization. Patients had continuous ECG monitoring during one session in week one, two and four. The data of 13 patients were available for analysis. Results showed a significant though limited increase of QTc with C1.5 (from 427 to 444 ms (start to end); p = 0.007) and with A1.25 (from 431 to 449 ms; p < 0.001), but not with A1.5 (from 439 to 443 ms; p = 0.13). In conclusion, we found that the use of C1.5 or A1.25 is associated with a significant prolongation of QTc which was however relatively limited.

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Calcium Profiling in Hemodiafiltration: A New Way to Reduce the Calcium Overload Risk without Compromising Cardiovascular Stability

Abstract: Pd(Ca) seems to retain the advantages of high Ca²⁺ in terms of hemodynamic stability and modification of QTc while reducing the excessive positive calcium balance typical of dialysis with high Ca²⁺ content.

Cited by 14 publications

References 31 publications

Dialysate and Serum Potassium in Hemodialysis

Dialysate and Serum Potassium in Hemodialysis

Noninvasive quantification of blood potassium concentration from ECG in hemodialysis patients

Effect of citric-acid dialysate on the QTC-interval

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