Electrocardiographic Changes during Hemodialysis with the Artificial Kidney

Rubin, Albert L.; Lubash, Glenn D.; Cohen, Bertram I.; Brailovsky, D; Braveman, Warren S.; Luckey, E. Hugh

doi:10.1161/01.cir.18.2.227

Cited by 19 publications

(5 citation statements)

References 18 publications

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“…Arrhythmias after dialysis have been encountered frequently by others [3,8,12], but they occurred only rarely in our series. In one of our cases ventricular escape with nodal rhythm followed an injection of digitalis made to treat shock believed to be of cardiac origin; d e l G r e c o and G ru m er reported a similar experience [3].…”

Section: S Ubjects and M Ethodsmentioning

confidence: 48%

Cardiodynamic Studies of Uremics Before and After Dialysis

Henderson¹,

Ambrosi²,

Starr³

1971

Nephron

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In 12 uremic patients, simultaneous records of the ballistocardiogram and the carotid pulse derivative were taken before and after 36 dialyses. The ECG was also taken in many cases. In the great majority of instances cardiac function remained normal or was unchanged by the dialyses. In a few cases it was definitely improved. However, in 8 instances the heart became weak and (or) incoordinate after dialysis, and in a few patients the abnormality was very striking. These adverse changes in cardiac function took place despite improvement in the blood levels of potassium and other electrolytes. Fortunately, our cases soon recovered from the cardiac damage. We must emphasize the interesting negative aspects of our results. The changes in plasma potassium encountered in our studies are among the largest to be found in the clinic, but they were not accompanied by consistent changes in the circulation. Repeatedly, great improvement in plasma potassium levels was not accompanied by any dynamic change in cardiac function detectable by our methods. Nor did the ECG change consistently. So the expectations generated by classic physiological experiments that abnormal levels of potassium have a deleterious effect on the circulation has no support from our results, probably because the situation of our patients, who had suffered from abnormal blood levels of electrolytes for months or years, was so very different from that in the acute experiments of the physiologists.

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Section: S Ubjects and M Ethodsmentioning

confidence: 48%

Cardiodynamic Studies of Uremics Before and After Dialysis

Henderson¹,

Ambrosi²,

Starr³

1971

Nephron

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“…There is no doubt, from the studies of Lown and Levine (21), that an elevated plasma K protects against, and lowered plasma K enhances ventricular ectopic beats. On the other hand, experimental evidence, suggesting that depletion of body K without altering plasma K "sensitizes" to digitalis, is less convincing (22,23). Regardless of the state of body K, there is very little, if any, evidence that K "antagonizes" any features of digitalis activity other than digitalis-induced arrhythmia.…”

Section: Resultsmentioning

confidence: 99%

Enhancement of Potassium-Induced Atrioventricular Block by Toxic Doses of Digitalis Drugs *

Fisch¹,

Martz²,

Priebe³

1960

J. Clin. Invest.

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“…Thus, these susceptible patients developed AF in the first 3 months, leaving a remaining risk set that is more tolerant of the stresses of the rapid fluid and electrolyte swings associated with thrice weekly HD, and therefore, more AF-resistant ('depletion of susceptibles'). 23 Indeed, the electrocardiographic changes with intermittent dialysis and its weight and electrolyte changes have been described as longas 60 years ago, 5 and its association with adverse outcomes in hemodialysis patients, such as increased sudden (cardiac) death and hospitalization remain of high interest to clinical investigators in HD today.…”

Section: Discussionmentioning

confidence: 99%

“…Patients undergoing HD are exposed to considerable cyclical changes in fluid and electrolyte status, with accumulation of fluid and uremic toxins, including potentially pro-arrhythmogenic electrolytes (potassium, calcium, magnesium) during the intradialytic interval followed by rapid fluid removal and electrolyte shifts during the relatively short HD procedure. 5 By contrast, PD confers a more continuous removal of excess fluids and maintenance of electrolyte balance, thus exercising less strain on the heart while reducing the burden of other potential AF triggers.…”

Section: Introductionmentioning

confidence: 99%