Electrolyte concentration during haemodialysis and QT interval prolongation in uraemic patients

Abstract

Changes in ventricular repolarization duration associated with HD largely depend on the concentrations of Ca(2+) and K(+) in the dialysis bath. These findings may have important implications for the choice of the electrolytes concentration of the dialysis bath during the HD session.

Electrocardiographic findings in chronic hemodialysis patients

“…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.…”

Sudden cardiac death in haemodialysis patients: Assessment of risk factors and prevention

“…Haemodialysis per se is a risk factor for arrhythmias due to rapid the electrolyte shifts and cardiovascular instability (intradialytic hypotension) that can occur with this treatment (10)(11)(12)(13). Rapid potassium and calcium shifts during HD sessions and low levels of electrolytes in the dialysate increase the risk for cardiac arrhythmia (10)(11)(12)(13).…”

“…Rapid potassium and calcium shifts during HD sessions and low levels of electrolytes in the dialysate increase the risk for cardiac arrhythmia (10)(11)(12)(13). The use of potassium-free or low-potassium dialysates (K + d = 1.0 mmol/L), particularly at the beginning of a dialysis session, removes potassium quickly, causing a rapid decline in the patient's serum potassium concentration, which may lead to a disturbance of ventricular myocardial repolarisation, an increase in the corrected QTc interval (QTd) dispersion and increased risk for ventricular arrhythmias (10)(11)(12)(13).…”

Late Ventricular Potentials in Cardiac and Extracardiac Diseases

“…Acute alcoholic states, binge drinking, the "holiday heart syndrome" and liver cirrhosis are associated with prolonged QT intervals and an increased prevalence of cardiac arrhythmias and SCD (Day et al, 1993;Genovesi et al, 2008;Wever & Robles de Medina, 2004;). In contrast, case-control studies have demonstrated a protective effect of moderate alcohol consumption against sudden cardiac death (Priori et al, 2001;Vreede-Swagemakers et al, 1999).…”