1
|
Kamei K, Yamada S, Hashimoto K, Konta T, Hamano T, Fukagawa M. The impact of low and high dialysate calcium concentrations on cardiovascular disease and death in patients undergoing maintenance hemodialysis: a systematic review and meta-analysis. Clin Exp Nephrol 2024; 28:557-570. [PMID: 38396314 DOI: 10.1007/s10157-024-02460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/08/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND The optimal dialysate calcium (Ca) concentration for patients undergoing hemodialysis remains inconclusive, particularly concerning cardiovascular protection. METHODS We conducted a systematic review of 19 randomized controlled trials (RCTs) and a meta-analysis of eight RCTs to determine the optimal dialysate Ca concentration for cardiovascular protection. We compared outcomes in patients receiving maintenance hemodialysis treated with either a low-Ca dialysate (LCD) (1.125 or 1.25 mmol/L) or a high-Ca dialysate (HCD) (1.5 or 1.75 mmol/L). The outcomes were coronary artery calcification score (CACS), all-cause and cardiovascular death, cardiovascular function and structure, and serum biochemical parameters. RESULTS There was no significant difference between LCD and HCD concerning CACS (standardized mean difference [SMD] = -0.16, 95% confidence interval [CI]: [-0.38, 0.07]), the risk of all-cause death, and cardiovascular death in patients treated with chronic maintenance hemodialysis. Conversely, LCD was associated with a significantly lower intima-media thickness (SMD = -0.49, 95% CI [-0.94, -0.05]) and pulse wave velocity than HCD (SMD = -0.86, 95% CI [-1.21, -0.51]). Furthermore, LCD significantly decreased serum Ca levels (mean difference [MD] = 0.52 mg/dL, 95% CI [0.19, 0.85]) and increased serum parathyroid hormone levels (MD = 44.8 pg/mL, 95% CI [16.2, 73.3]) compared with HCD. Notably, most RCTs examined in our analysis did not include patients receiving calcimimetics. CONCLUSIONS Our meta-analysis showed no significant differences in cardiovascular calcification and death between LCD and HCD and revealed a paucity of RCTs on dialysate Ca concentrations, including those involving patients on calcimimetics, indicating the urgent need for further studies.
Collapse
Affiliation(s)
- Keita Kamei
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tsuneo Konta
- Department of Public Health and Hygiene, Yamagata University School of Medicine, Yamagata, Japan
| | - Takayuki Hamano
- Department of Nephrology, Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| |
Collapse
|
2
|
Junho CVC, Frisch J, Soppert J, Wollenhaupt J, Noels H. Cardiomyopathy in chronic kidney disease: clinical features, biomarkers and the contribution of murine models in understanding pathophysiology. Clin Kidney J 2023; 16:1786-1803. [PMID: 37915935 PMCID: PMC10616472 DOI: 10.1093/ckj/sfad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Indexed: 11/03/2023] Open
Abstract
The cardiorenal syndrome (CRS) is described as a multi-organ disease encompassing bidirectionally heart and kidney. In CRS type 4, chronic kidney disease (CKD) leads to cardiac injury. Different pathological mechanisms have been identified to contribute to the establishment of CKD-induced cardiomyopathy, including a neurohormonal dysregulation, disturbances in the mineral metabolism and an accumulation of uremic toxins, playing an important role in the development of inflammation and oxidative stress. Combined, this leads to cardiac dysfunction and cardiac pathophysiological and morphological changes, like left ventricular hypertrophy, myocardial fibrosis and cardiac electrical changes. Given that around 80% of dialysis patients suffer from uremic cardiomyopathy, the study of cardiac outcomes in CKD is clinically highly relevant. The present review summarizes clinical features and biomarkers of CKD-induced cardiomyopathy and discusses underlying pathophysiological mechanisms recently uncovered in the literature. It discloses how animal models have contributed to the understanding of pathological kidney-heart crosstalk, but also provides insights into the variability in observed effects of CKD on the heart in different CKD mouse models, covering both "single hit" as well as "multifactorial hit" models. Overall, this review aims to support research progress in the field of CKD-induced cardiomyopathy.
Collapse
Affiliation(s)
| | - Janina Frisch
- Department of Biophysics, Center for Integrative Physiology and Molecular Medicine, Medical Faculty, Saarland University, Center for Human and Molecular Biology, Homburg/Saar, Germany
| | - Josefin Soppert
- Institute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH Aachen, Aachen, Germany
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Julia Wollenhaupt
- Institute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH Aachen, Aachen, Germany
| | - Heidi Noels
- Institute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH Aachen, Aachen, Germany
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
3
|
Soomro QH, Bansal N, Winkelmayer WC, Koplan BA, Costea AI, Roy-Chaudhury P, Tumlin JA, Kher V, Williamson DE, Pokhariyal S, McClure CK, Charytan DM. Association of Bradycardia and Asystole Episodes with Dialytic Parameters: An Analysis of the Monitoring in Dialysis (MiD) Study. KIDNEY360 2022; 3:1871-1880. [PMID: 36514397 PMCID: PMC9717630 DOI: 10.34067/kid.0003142022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022]
Abstract
Background Bradycardia and asystole events are common among patients treated with maintenance hemodialysis. However, triggers of these events in patients on maintenance hemodialysis (HD), particularly during the long interdialytic period when these events cluster, are uncertain. Methods The Monitoring in Dialysis Study (MiD) enrolled 66 patients on maintenance HD who were implanted with loop recorders and followed for 6 months. We analyzed associations of predialysis laboratory values with clinically significant bradyarrhythmia or asystole (CSBA) during the 12 hours before an HD session. Associations with CSBA were analyzed with mixed-effect models. Adjusted negative binomial mixed-effect regression was used to estimate incidence rate ratios (IRR) for CSBA. We additionally evaluated associations of CSBA at any time during follow-up with time-averaged dialytic and laboratory parameters and associations of peridialytic parameters with occurrence of CSBA from the start of one HD session to the beginning of the next. Results There were 551 CSBA that occurred in the last 12 hours of the interdialytic interval preceding 100 HD sessions in 12% of patients and 1475 CSBA events in 23% of patients overall. We did not identify significant associations between dialytic parameters or serum electrolytes and CSBA in the last 12 hours of the interdialytic interval in adjusted analyses. Median time-averaged ultrafiltration rate was significantly higher in individuals without CSBA (9.8 versus 8, P=0.04). Use of dialysate sodium concentrations ≤135 (versus 140) mEq/L was associated with a reduced risk of CSBA from the start of one session to the beginning of next. Conclusions Although a few factors had modest associations with CSBA in some analyses, we did not identify any robust associations of modifiable parameters with CSBA in the MiD Study. Further investigation is needed to understand the high rates of arrhythmia in the hemodialysis population.
Collapse
Affiliation(s)
- Qandeel H. Soomro
- Nephrology Division, Department of Medicine, NYU Langone Medical Center, New York, New York
| | - Nisha Bansal
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Wolfgang C. Winkelmayer
- Section of Nephrology, Selzman Institute for Kidney Health, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Internal Medicine/Nephrology, Emory University, Atlanta, Georgia
| | | | | | - Prabir Roy-Chaudhury
- University of North Carolina Kidney Center, Chapel Hill, North Carolina
- WG (Bill) Hefner VA Medical Center, Salisbury, North Carolina
| | - James A. Tumlin
- Georgia Nephrology Clinical Research Institute, Atlanta, Georgia
| | - Vijay Kher
- Fortis Escorts Kidney and Urology Institute, Fortis Escorts Hospital, New Delhi, India
| | | | | | | | - David M. Charytan
- Nephrology Division, Department of Medicine, NYU Langone Medical Center, New York, New York
| |
Collapse
|
4
|
Genovesi S, Regolisti G, Burlacu A, Covic A, Combe C, Mitra S, Basile C. The conundrum of the complex relationship between acute kidney injury and cardiac arrhythmias. Nephrol Dial Transplant 2022; 38:1097-1112. [PMID: 35777072 DOI: 10.1093/ndt/gfac210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Acute kidney injury (AKI) is defined by a rapid increase in serum creatinine levels, reduced urine output, or both. Death may occur in 16%-49% of patients admitted to an intensive care unit with severe AKI. Complex arrhythmias are a potentially serious complication in AKI patients with pre-existing or AKI-induced heart damage and myocardial dysfunction, fluid overload, and especially electrolyte and acid-base disorders representing the pathogenetic mechanisms of arrhythmogenesis. Cardiac arrhythmias, in turn, increase the risk of poor renal outcomes, including AKI. Arrhythmic risk in AKI patients receiving kidney replacement treatment may be reduced by modifying dialysis/replacement fluid composition. The most common arrhythmia observed in AKI patients is atrial fibrillation. Severe hyperkalemia, sometimes combined with hypocalcemia, causes severe bradyarrhythmias in this clinical setting. Although the likelihood of life-threatening ventricular arrhythmias is reportedly low, the combination of cardiac ischemia and specific electrolyte or acid-base abnormalities may increase this risk, particularly in AKI patients who require kidney replacement treatment. The purpose of this review is to summarize the available epidemiological, pathophysiological, and prognostic evidence aiming to clarify the complex relationships between AKI and cardiac arrhythmias.
Collapse
Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano - Bicocca, Nephrology Clinic, Monza, Italy.,Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giuseppe Regolisti
- Clinica e Immunologia Medica -Azienda Ospedaliero-Universitaria e Università degli Studi di Parma, Parma, Italy
| | - Alexandru Burlacu
- Department of Interventional Cardiology - Cardiovascular Diseases Institute, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Adrian Covic
- Nephrology Clinic, Dialysis, and Renal Transplant Center - 'C.I. Parhon' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, and Unité INSERM 1026, Université de Bordeaux, Bordeaux, France
| | - Sandip Mitra
- Department of Nephrology, Manchester Academy of Health Sciences Centre, Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, UK
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
| | | |
Collapse
|
5
|
Guía de unidades de hemodiálisis 2020. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
6
|
Genovesi S, Boriani G, Covic A, Vernooij RWM, Combe C, Burlacu A, Davenport A, Kanbay M, Kirmizis D, Schneditz D, van der Sande F, Basile C. Sudden cardiac death in dialysis patients: different causes and management strategies. Nephrol Dial Transplant 2021; 36:396-405. [PMID: 31538192 DOI: 10.1093/ndt/gfz182] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/01/2019] [Indexed: 01/12/2023] Open
Abstract
Sudden cardiac death (SCD) represents a major cause of death in end-stage kidney disease (ESKD). The precise estimate of its incidence is difficult to establish because studies on the incidence of SCD in ESKD are often combined with those related to sudden cardiac arrest (SCA) occurring during a haemodialysis (HD) session. The aim of the European Dialysis Working Group of ERA-EDTA was to critically review the current literature examining the causes of extradialysis SCD and intradialysis SCA in ESKD patients and potential management strategies to reduce the incidence of such events. Extradialysis SCD and intradialysis SCA represent different clinical situations and should be kept distinct. Regarding the problem, numerically less relevant, of patients affected by intradialysis SCA, some modifiable risk factors have been identified, such as a low concentration of potassium and calcium in the dialysate, and some advantages linked to the presence of automated external defibrillators in dialysis units have been documented. The problem of extra-dialysis SCD is more complex. A reduced left ventricular ejection fraction associated with SCD is present only in a minority of cases occurring in HD patients. This is the proof that SCD occurring in ESKD has different characteristics compared with SCD occurring in patients with ischaemic heart disease and/or heart failure and not affected by ESKD. Recent evidence suggests that the fatal arrhythmia in this population may be due more frequently to bradyarrhythmias than to tachyarrhythmias. This fact may partly explain why several studies could not demonstrate an advantage of implantable cardioverter defibrillators in preventing SCD in ESKD patients. Electrolyte imbalances, frequently present in HD patients, could explain part of the arrhythmic phenomena, as suggested by the relationship between SCD and timing of the HD session. However, the high incidence of SCD in patients on peritoneal dialysis suggests that other risk factors due to cardiac comorbidities and uraemia per se may contribute to sudden mortality in ESKD patients.
Collapse
Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Nephrology Unit, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena University Hospital, Modena, Italy
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center - 'C.I. Parhon' University Hospital, Iasi, Romania.,'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Unité INSERM 1026, Université de Bordeaux, Bordeaux, France
| | - Alexandru Burlacu
- 'Grigore T. Popa' University of Medicine, Iasi, Romania.,Department of Interventional Cardiology - Cardiovascular Diseases Institute, Iasi, Romania
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, Division of Medicine, University College London, London, UK
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | | | - Daniel Schneditz
- Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Frank van der Sande
- Division of Nephrology, Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy.,Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
| | | |
Collapse
|
7
|
Effect of citric-acid dialysate on the QTC-interval. Sci Rep 2021; 11:9909. [PMID: 33972581 PMCID: PMC8110800 DOI: 10.1038/s41598-021-89083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
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.
Collapse
|
8
|
Krogager ML, Kragholm K, Thomassen JQ, Søgaard P, Lewis BS, Wassmann S, Baumgartner I, Ceconi C, Schmidt TA, Kaski JC, Drexel H, Semb AG, Agewall S, Niessner A, Savarese G, Kjeldsen KP, Borghi C, Tamargo J, Torp-Pedersen C. Update on management of hypokalemia and goals for the lower potassium level in patients with cardiovascular disease: A review in collaboration with the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2021; 7:557-567. [PMID: 33956964 DOI: 10.1093/ehjcvp/pvab038] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/04/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Hypokalaemia is common in patients with cardiovascular disease. In this review, we emphasize the importance of tight potassium regulation in patients with cardiovascular disease based on findings from observational studies. To enhance the understanding, we also describe the mechanisms of potassium homeostasis maintenance, the most common causes of hypokalaemia and present strategies for monitoring and management of low potassium levels. We propose elevation of potassium in asymptomatic patients with lower normal concentrations and concurrent cardiovascular disease. These proposals are intended to assist clinicians until more evidence is available.
Collapse
Affiliation(s)
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University hospital, Aalborg, Denmark.,Department of Cardiology, Region Hospital North Jutland, Hjørring, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Qvist Thomassen
- Department of Clinical Biochemistry, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University hospital, Aalborg, Denmark
| | - Basil S Lewis
- Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel
| | - Sven Wassmann
- Cardiology Pasing, Munich, Germany and University of the Saarland, Homburg/Saar, Germany
| | - Iris Baumgartner
- Department of Angiology, Bern University Hospital (Inselspital), Bern, Switzerland
| | - Claudio Ceconi
- Department of Cardiology, Desenzano Del Garda Hospital, Italy
| | - Thomas Andersen Schmidt
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,The Emergency Department, North Zealand University Hospital, Hillerød, Denmark
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Landeskrankenhaus, Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Anne Grete Semb
- Preventive Cardio-Rheuma clinic, Depatment Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Stefan Agewall
- Department of Cardiology, Ullevål, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Sciences, Søsterhjemmet, University of Oslo, Oslo, Norway
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Instituttet, Stockholm, Sweden
| | - Keld Per Kjeldsen
- Department of Cardiology, Copenhagen University Hospital (Amager-Hvidovre), Copenhagen, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, CIBERCV, University Complutense, 28040, Madrid, Spain
| | | |
Collapse
|
9
|
Evalution of Tp-E Interval on Electrocardiography Recordings in Elderly Hemodialysis Patients And Its Associations With Electrolyte Imbalances. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2021. [DOI: 10.21673/anadoluklin.790495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
10
|
Liu P, Wang L, Han D, Sun C, Xue X, Li G. Acquired long QT syndrome in chronic kidney disease patients. Ren Fail 2020; 42:54-65. [PMID: 31878817 PMCID: PMC6968512 DOI: 10.1080/0886022x.2019.1707098] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 11/30/2019] [Accepted: 12/01/2019] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in chronic kidney disease (CKD) patients. QT interval prolongation is a congenital or acquired condition that is associated with an increased risk of torsade de pointes (TdP), sudden cardiac death (SCD), and all-cause mortality in the general population. The prevalence of acquired long QT syndrome (aLQTS) is high, and various acquired conditions contribute to the prolonged QT interval in patients with CKD. More notably, the prolonged QT interval in CKD is an independent risk factor for SCD and all-cause mortality. In this review, we focus on the epidemiological characteristics, risk factors, underlying mechanisms and treatments of aLQTS in CKD, promoting the management of aLQTS in CKD patients.
Collapse
Affiliation(s)
- Peng Liu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China;
| | - Lu Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China;
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Dan Han
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China;
| | - Chaofeng Sun
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China;
| | - Xiaolin Xue
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China;
| | - Guoliang Li
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China;
| |
Collapse
|
11
|
Umapathi KK, Lee S, Jacobson J, Jandeska S, Nguyen HH. Magnesium Supplementation Shortens Hemodialysis-Associated Prolonged QT. Cureus 2020; 12:e9132. [PMID: 32670733 PMCID: PMC7358902 DOI: 10.7759/cureus.9132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Hemodialysis affects myocardial depolarization and repolarization notably lengthening the QT interval. Prolonged QT, in turn, has been a reliable surrogate for higher risk of potentially lethal ventricular arrhythmias. We present an adolescent girl with end-stage kidney disease who consistently developed prolonged QT following hemodialysis sessions. Interestingly, her QT intervals were inversely correlated with her serum magnesium levels. Magnesium supplementation appeared to help reduce the QT prolongation after hemodialysis. Our case shows the potential utility of magnesium as a cardioprotective agent in hemodialysis patients. We recommend that patients undergoing hemodialysis receive frequent electrocardiograms and electrolytes monitoring for tailored electrolytes management to reduce the risk of developing potentially lethal cardiac arrhythmias.
Collapse
Affiliation(s)
| | - Sunah Lee
- Pediatrics, Childrens Hospital of Los Angeles, Los Angeles, USA
| | - Jessica Jacobson
- Pharmacology and Therapeutics, Rush University Medical Center, Chicago, USA
| | - Sara Jandeska
- Pediatric Nephrology, Rush University Medical Center, Chicago, USA
| | - Hoang H Nguyen
- Pediatrics, University of Texas Southwestern Medical Center, Dallas, USA.,Pediatrics, Rush University Medical Center, Chicago, USA
| |
Collapse
|
12
|
Yildiz A, Akkaya V, Sahin S, Tükek T, Besler M, Bozfakioglu S, Korkut F. Qt Dispersion and Signal-Averaged Electrocardiogram in Hemodialysis and Capd Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080102100213] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to compare QT dispersion (QTd) and signal-averaged electrocardiogram (SA-ECG) parameters that may predict risk of malignant arrhythmias in patients on hemodialysis (HD), on continuous ambulatory peritoneal dialysis (CAPD), and in controls. Setting Controlled cross-sectional study in a tertiary- care setting. Patients 28 HD (M/F 18/10; mean age 32 ± 9 years), 29 CAPD (M/F 17/12; mean age 34 ± 10 years), and 29 healthy controls (M/F 17/12; mean age 32 ± 8 years) were included. Interventions On ECG, minimum (QTmin) and maximum (QTmax) QT duration and their difference (QTd) were measured. In SA-ECG, duration of filtered QRS, HFLA signals less than 40 μV, and RMS voltage (40 ms) were also measured. Results Higher serum Ca2+ and lower K+ levels were found in CAPD compared to HD. All QT parameters were increased in HD and CAPD compared to controls. QT dispersion was significantly prolonged in HD compared to CAPD. In HD, QTd was correlated with left ventricular (LV) mass index ( r = 0.53, p = 0.004), but not in CAPD ( r = -0.09, p = 0.63). QT dispersion was significantly prolonged in patients with LV hypertrophy compared to patients without hypertrophy on HD (68 ± 18 ms vs 49 ± 18 ms, p = 0.008). In the analysis of SA-ECG, 3 of the 28 (11%) HD and 2 of the 29 (7%) CAPD patients had abnormal late potentials. Patients on HD and CAPD had significantly higher filtered-QRS duration compared to controls (105 ± 15 ms and 104 ± 12 ms vs 95 ± 5 ms, respectively, p = 0.04). Patients with LV hypertrophy had higher filtered-QRS duration compared to patients without hypertrophy (109 ± 12 ms vs 95 ± 8 ms, p < 0.001). Conclusion Dialysis patients had prolonged QTd and increased filtered-QRS duration in SA-ECG compared to controls. Patients on HD had longer QTd than patients on CAPD. QTd has been correlated to LV mass index in HD, but not in CAPD. This difference might be due to the effect of different dialysis modalities on electrolytes, especially the higher serum Ca2+ levels.
Collapse
Affiliation(s)
- Alaattin Yildiz
- Division of Nephrology, Department of Internal Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| | - Vakur Akkaya
- Department of Cardiology, Istanbul School of Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| | - Sevgi Sahin
- Division of Nephrology, Department of Internal Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| | - Tufan Tükek
- Department of Cardiology, Istanbul School of Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| | - Mine Besler
- Division of Nephrology, Department of Internal Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| | - Semra Bozfakioglu
- Division of Nephrology, Department of Internal Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| | - Ferruh Korkut
- Department of Cardiology, Istanbul School of Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| |
Collapse
|
13
|
Kirmizis D, Basile C. Calcium balance in hemodialysis: More uncertainty than certainty. Semin Dial 2020; 33:103-108. [PMID: 31913542 DOI: 10.1111/sdi.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is controversy about the choice of dialysate calcium concentration (DCa), with strong arguments both in favor of and against the use of a low or high DCa, as they can both be potentially harmful. Evidence suggests that calcium mass balance is positive with a DCa 3.5 mEq/L, negative or neutral with the use of DCa 2.5 mEq/L, whereas both positive and negative balances have been observed with the use of DCa 3.0 mEq/L. Overall, the use of DCa >2.5 mEq/L is usually associated with an increase in serum calcium level and a decrease in serum PTH level and use of lower vitamin D analogue dose, with the opposite effects usually observed with the use of lower DCa. Most of the available evidence is from small-sized and crossover studies; hence, evidence should be regarded with caution and applied in a patient-specific manner. As there are a lot of significant unanswered questions regarding calcium balance and the optimal DCa in hemodialysis patients, further high-quality research is needed to clarify many still unclear aspects of calcium homeostasis and balance in these patients. In conclusion, with the existing evidence the choice of DCa needs to be individualized and contextualized in the setting of each patient's calcium balance needs and homeostatic response, taking also into account oral calcium intake (dietary and medicinal), any other relevant therapy administered, such as vitamin D analogues, the type of renal mineral bone disorder, and associated cardiovascular comorbidity.
Collapse
Affiliation(s)
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy.,Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
| |
Collapse
|
14
|
Delanaye P, Krzesinski F, Dubois BE, Delcour A, Robinet S, Piette C, Krzesinski JM, Lancellotti P. A simple modification of dialysate potassium: its impact on plasma potassium concentrations and the electrocardiogram. Clin Kidney J 2019; 14:390-397. [PMID: 33564443 PMCID: PMC7857800 DOI: 10.1093/ckj/sfz157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/02/2019] [Indexed: 11/14/2022] Open
Abstract
Background Sudden death is frequent in haemodialysis (HD) patients. Both hyperkalaemia and change of plasma potassium (K) concentrations induced by HD could explain this. The impact of increasing dialysate K by 1 mEq/L on plasma K concentrations and electrocardiogram (ECG) results before and after HD sessions was studied. Methods Patients with pre-dialysis K >5.5 mEq/L were excluded. ECG and K measurements were obtained before and after the first session of the week for 2 weeks. Then, K in the dialysate was increased (from 1 or 3 to 2 or 4 mEq/L, respectively). Blood and ECG measurements were repeated after 2 weeks of this change. Results Twenty-seven prevalent HD patients were included. As expected, a significant decrease in K concentrations was observed after the dialysis session, but this decrease was significantly lower after the switch to an increased dialysate K. The pre-dialysis K concentrations were not different after changing, but post-dialysis K concentrations were higher after switching (P < 0.0001), with a lower incidence of post-dialysis hypokalaemia. Regarding ECG, before switching, the QT interval (QT) dispersion increased during the session, whereas no difference was observed after switching. One week after switching, post-dialysis QT dispersion [38 (34-42) ms] was lower than post-dialysis QT dispersion 2 weeks and 1 week before switching [42 (38-57) ms, P = 0.0004; and 40 (35-50) ms, P = 0.0002]. Conclusions A simple increase of 1 mEq/L of K in the dialysate is associated with a lower risk of hypokalaemia and a lower QT dispersion after the dialysis session. Further study is needed to determine if such a strategy is associated with a lower risk of sudden death.
Collapse
Affiliation(s)
- Pierre Delanaye
- Department of Nephrology, Dialysis, Transplantation, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium.,GIGA Cardiovascular Sciences, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - François Krzesinski
- Department of Cardiology, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Bernard E Dubois
- Department of Nephrology, Dialysis, Transplantation, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Alexandre Delcour
- Department of Cardiology, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Sébastien Robinet
- Department of Cardiology, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Caroline Piette
- Department of Cardiology, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Jean-Marie Krzesinski
- Department of Nephrology, Dialysis, Transplantation, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium.,GIGA Cardiovascular Sciences, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium.,Department of Cardiology, University of Liège (ULg CHU), CHU Sart Tilman, Liège, Belgium
| |
Collapse
|
15
|
Sakoh T, Taniguchi M, Yamada S, Ohnaka S, Arase H, Tokumoto M, Yanagida T, Mitsuiki K, Hirakata H, Nakano T, Kitazono T, Tsuruya K. Short- and Long-term Effects of Dialysate Calcium Concentrations on Mineral and Bone Metabolism in Hemodialysis Patients: The K4 Study. Kidney Med 2019; 1:296-306. [PMID: 32734210 PMCID: PMC7380384 DOI: 10.1016/j.xkme.2019.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE & OBJECTIVE The short- and long-term impact of conversion of dialysate calcium concentration from either 2.5 or 3.0 mEq/L to 2.75 mEq/L on mineral and bone metabolism remains unknown in hemodialysis patients. STUDY DESIGN Nonrandomized intervention study. SETTING & POPULATION 12 hemodialysis patients treated at baseline with a 2.5-mEq/L dialysate calcium concentration and another 12 hemodialysis patients treated with a 3.0-mEq/L dialysate calcium concentration. INTERVENTION Use of 2.75-mEq/L dialysate calcium concentration. OUTCOMES Changes in intradialytic calcium and phosphate clearance and changes in predialysis and intradialytic serum and ionized mineral and biochemical parameters over the 24 weeks following dialysate calcium conversion. RESULTS Conversion of dialysate calcium concentration from 2.5 to 2.75 mEq/L increased intradialytic calcium loading and serum total and ionized calcium levels, whereas conversion of dialysate calcium from 3.0 to 2.75 mEq/L decreased intradialytic calcium loading and serum total and ionized calcium levels. Dialysate calcium concentration conversion did not affect intradialytic serum parathyroid hormone level, intradialytic phosphate elimination, or predialysis serum calcium, phosphate, parathyroid hormone, and fibroblast growth factor 23 levels. Intradialytic calcium influx was determined by dialysate calcium concentration and predialysis serum calcium levels, whereas intradialytic phosphate elimination was determined by predialysis serum phosphate levels. LIMITATIONS Small sample size and no control groups treated with 2.5- and 3.0-mEq/L dialysate calcium concentrations during the 24 weeks of the observation period. CONCLUSIONS Conversion of dialysate calcium concentration from either 3.0 or 2.5 to 2.75 mEq/L results in expected changes in calcium loading based on predialysis calcium concentration. The dialysate calcium concentration should be personalized based on clinical factors. FUNDING None. TRIAL REGISTRATION University Hospital Medical Information Network, www.umin.ac.jp/english/, R000040105, UMIN000035184.
Collapse
Affiliation(s)
- Teppei Sakoh
- Division of Nephrology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | | | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shotaro Ohnaka
- Division of Nephrology, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Tokumoto
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Taihei Yanagida
- Division of Nephrology, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Koji Mitsuiki
- Division of Nephrology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Hideki Hirakata
- Division of Nephrology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan.,Fukuoka Renal Clinic, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Nephrology, Nara Medical University, Nara, Japan
| |
Collapse
|
16
|
Kim ED, Watt J, Tereshchenko LG, Jaar BG, Sozio SM, Kao WHL, Estrella MM, Parekh RS. Associations of serum and dialysate electrolytes with QT interval and prolongation in incident hemodialysis: the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study. BMC Nephrol 2019; 20:133. [PMID: 30999887 PMCID: PMC6474045 DOI: 10.1186/s12882-019-1282-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 03/06/2019] [Indexed: 01/08/2023] Open
Abstract
Background Prolonged QT interval in hemodialysis patients may be associated with sudden cardiac death, however, few studies examined the longitudinal associations of modifiable factors such as serum and dialysate concentrations of calcium, potassium, and magnesium with corrected QT (QTc) prolongation in incident hemodialysis patients. Methods In 330 in-center hemodialysis participants from the PACE study who were followed up for one year, we examined the associations of predialysis serum electrolytes (total calcium [Ca], corrected Ca [cCa], ionized Ca [iCa], potassium [K], magnesium [Mg]), dialysate (dCa and dK), and serum-to-dialysate gradient measures with QTc interval and prolongation (≥460 ms in women and ≥ 450 ms in men). Results At the first study visit, 47% had QTc prolongation. Lower iCa and K were associated with longer QTc interval independent of potential confounders (QTc difference = 8.55[95% CI: 2.13, 14.97] ms for iCa; QTc difference = 9.89[1.58, 18.20] ms for K). Lower iCa was also associated with a higher risk of QTc prolongation. At 1 year of follow-up, 31% had persistent QTc prolongation. In longitudinal analyses, the associations of iCa and K with QTc interval remained significant, and lower K was associated with a higher risk of QTc prolongation while the association of iCa with QTc prolongation was borderline statistically significant. Serum Mg, dCa or dK, and respective gradients were not associated with QTc interval or prolongation. Conclusion Prolonged QTc is very common in incident hemodialysis participants and persists over follow-up. Ionized Ca and K are consistently inversely associated with QTc prolongation, which suggests closer monitoring for a low calcium or potassium level to mitigate risk. Electronic supplementary material The online version of this article (10.1186/s12882-019-1282-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Esther D Kim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| | - Jacqueline Watt
- Child Health Evaluative Sciences, The Hospital for Sick Children, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernard G Jaar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Nephrology Center of Maryland, Baltimore, MD, USA
| | - Stephen M Sozio
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - W H Linda Kao
- Johns Hopkins University, School of Public Health, Baltimore, Maryland, USA
| | - Michelle M Estrella
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rulan S Parekh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Child Health Evaluative Sciences, The Hospital for Sick Children, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. .,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, 555 University Ave, Toronto, ON, Canada.
| |
Collapse
|
17
|
Alqahtani F, Almustafa A, Shah K, Akram Y, Abbasi D, Rattan R, Subrayappa N, Alkhouli M, Munir MB. Sudden cardiac arrest in end-stage renal disease patients on dialysis: A nationwide study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1467-1475. [PMID: 30225901 DOI: 10.1111/pace.13498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/06/2018] [Accepted: 09/09/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Fahad Alqahtani
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Ahmed Almustafa
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Kuldeep Shah
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Yasir Akram
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Danish Abbasi
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Rohit Rattan
- Department of Cardiology; Heart and Vascular Institute, University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Navin Subrayappa
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Mohamad Alkhouli
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| | - Muhammad Bilal Munir
- Department of Cardiology; West Virginia University Heart and Vascular Institute; Morgantown WV USA
| |
Collapse
|
18
|
Sohal PM, Goel A, Gupta D, Aslam N, Sandhu J, Sandhu JS, John EE, Sharma D. Effect of Hemodialysis on Corrected QT Interval and QTc Dispersion. Indian J Nephrol 2018; 28:335-338. [PMID: 30270992 PMCID: PMC6146738 DOI: 10.4103/ijn.ijn_15_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Hemodialysis patients are at higher risk of cardiovascular disease due to traditional and dialysis-related risk factors. Our aim was to study the effects of hemodialysis on the corrected QT interval (QTc) and QTc dispersion in chronic kidney disease (CKD) without clinically manifest heart disease. Two hundred cases of CKD on chronic intermittent hemodialysis of >3 months' duration were included in the study. Twelve-lead electrocardiography and samples for serum creatinine, potassium, calcium, and magnesium were taken before and after dialysis. The mean age of patients was 52.4 ± 17 years with male-to-female ratio of 3:1. QTc interval and QTc dispersion were prolonged in 47% and 59% before and 50% and 89% of patients after hemodialysis, respectively. The mean values of QTc were 433.4 ± 36.9 ms before and 451.4 ± 39.6 ms after hemodialysis (p = 0.001) and the mean values of QTc dispersion were 60.5 ± 19.3 ms before and 81.5 ± 24.4 ms after hemodialysis (p = 0.001). Similar pattern was observed in all etiological groups of CKD, except for QTc dispersion in malignancy-related CKD (p = 0.216). After hemodialysis, there was a significant fall in the mean values of serum potassium (p = 0.001), rise in serum calcium (p = 0.001), and no change in magnesium (p = 0.424). Patients with post hemodialysis QTc dispersion >74 ms had significantly low mean values of serum potassium and calcium as compared to <74 ms group. Large numbers of hemodialysis patients have a prolonged QTc interval and QTc dispersion with a significant increase in the mean values after hemodialysis. There is a significant fall in serum potassium and rise in serum calcium after dialysis.
Collapse
Affiliation(s)
- P. M. Sohal
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - A. Goel
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - D. Gupta
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - N. Aslam
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - J. Sandhu
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - J. S. Sandhu
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - E. E. John
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - D. Sharma
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
19
|
Wen Y, Gan H, Li Z, Sun X, Xiong Y, Xia Y. Safety of Low-calcium Dialysate and its Effects on Coronary Artery Calcification in Patients Undergoing Maintenance Hemodialysis. Sci Rep 2018; 8:5941. [PMID: 29654308 PMCID: PMC5899126 DOI: 10.1038/s41598-018-24397-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/03/2018] [Indexed: 11/09/2022] Open
Abstract
To determine the safety of low-calcium-dialysate in patients undergoing maintenance hemodialysis (MHD) and its effects on coronary artery calcification (CAC) and analyze clinical risk factors for CAC. A total of 174 MHD patients were recruited and randomly divided into two groups: high-calcium dialysate (HCD, 1.5 mmol/L Ca2+) and low-calcium dialysate (LCD, 1.25 mmol/L Ca2+). Changes in CAC score (CACS) and cardiac function were evaluated using spiral computed tomography and echocardiography, respectively. Clinical and laboratory parameters were measured. Intra-dialysis adverse reactions were recorded and compared between the two groups. CACS was significantly lower in the LCD group than in the HCD group by the end of the study. Cardiac E/Amax was significantly higher in the LCD group than in the HCD group by the end of the study. There was no significant difference in the frequency of any intra-dialysis adverse reactions between the two groups during the study. LCD is helpful in maintaining cardiac diastolic function and postponing CAC progression. LCD does not increase intra-dialysis adverse reactions. Age may be the most important factor impacting CAC in MHD patients.
Collapse
Affiliation(s)
- Yang Wen
- The first affiliated hospital of Chongqing Medical University, Department of Nephrology, Chongqing, 400016, China
| | - Hua Gan
- The first affiliated hospital of Chongqing Medical University, Department of Nephrology, Chongqing, 400016, China
| | - Zhengrong Li
- The first affiliated hospital of Chongqing Medical University, Department of Nephrology, Chongqing, 400016, China
| | - Ximin Sun
- The first hospital affiliated to Army Medical University, Department of Hepatology, Chongqing, 400038, China
| | - Ying Xiong
- The first affiliated hospital of Chongqing Medical University, Department of Nephrology, Chongqing, 400016, China
| | - Yunfeng Xia
- The first affiliated hospital of Chongqing Medical University, Department of Nephrology, Chongqing, 400016, China.
| |
Collapse
|
20
|
Vervloet MG, van Ballegooijen AJ. Prevention and treatment of hyperphosphatemia in chronic kidney disease. Kidney Int 2018; 93:1060-1072. [PMID: 29580635 DOI: 10.1016/j.kint.2017.11.036] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/21/2017] [Accepted: 11/27/2017] [Indexed: 12/20/2022]
Abstract
Hyperphosphatemia has consistently been shown to be associated with dismal outcome in a wide variety of populations, particularly in chronic kidney disease (CKD). Compelling evidence from basic and animal studies elucidated a range of mechanisms by which phosphate may exert its pathological effects and motivated interventions to treat hyperphosphatemia. These interventions consisted of dietary modifications and phosphate binders. However, the beneficial effects of these treatment methods on hard clinical outcomes have not been convincingly demonstrated in prospective clinical trials. In addition, exposure to high amounts of dietary phosphate may exert untoward actions even in the absence of overt hyperphosphatemia. Based on this concept, it has been proposed that the same interventions used in CKD patients with normal phosphate concentrations be used in the presence of hyperphosphatemia to prevent rise of phosphate concentration and as an early intervention for cardiovascular risk. This review describes conceptual models of phosphate toxicity, summarizes the evidence base for treatment and prevention of hyperphosphatemia, and identifies important knowledge gaps in the field.
Collapse
Affiliation(s)
- Marc G Vervloet
- Department of Nephrology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands.
| | - Adriana J van Ballegooijen
- Department of Nephrology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
21
|
Abstract
Hyperkalemia is a frequently detected electrolyte abnormality that can cause life-threatening complications. Hyperkalemia is most often the result of intrinsic (decreased glomerular filtration rate; selective reduction in distal tubule secretory function; impaired mineralocorticoid activity; and metabolic disturbances, such as acidemia and hyperglycemia) and extrinsic factors (e.g., drugs, such as renin-angiotensin-aldosterone system inhibitors, and potassium intake). The frequent use of renin-angiotensin-aldosterone system inhibitors in patients who are already susceptible to hyperkalemia (e.g., patients with chronic kidney disease, diabetes mellitus, or congestive heart failure) contributes to the high incidence of hyperkalemia. There is a need to understand the causes of hyperkalemia and to be aware of strategies addressing the disorder in a way that provides the most optimal outcome for affected patients. The recent development of 2 new oral potassium-binding agents has led to the emergence of a new paradigm in the treatment of hyperkalemia.
Collapse
Affiliation(s)
- Linda Fried
- Medicine, Epidemiology, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Csaba P Kovesdy
- Clinical Outcomes and Clinical Trials Program in Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Biff F Palmer
- Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
22
|
Kovesdy CP, Appel LJ, Grams ME, Gutekunst L, McCullough PA, Palmer BF, Pitt B, Sica DA, Townsend RR. Potassium homeostasis in health and disease: A scientific workshop cosponsored by the National Kidney Foundation and the American Society of Hypertension. ACTA ACUST UNITED AC 2017; 11:783-800. [PMID: 29030153 DOI: 10.1016/j.jash.2017.09.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 12/16/2022]
Abstract
While much emphasis, and some controversy, centers on recommendations for sodium intake, there has been considerably less interest in recommendations for dietary potassium intake, in both the general population and patients with medical conditions, particularly acute and chronic kidney disease. Physiology literature and cohort studies have noted that the relative balance in sodium and potassium intakes is an important determinant of many of the sodium-related outcomes. A noteworthy characteristic of potassium in clinical medicine is the extreme concern shared by many practitioners when confronted by a patient with hyperkalemia. Fear of this often asymptomatic finding limits enthusiasm for recommending potassium intake and often limits the use of renin-angiotensin-aldosterone system blockers in patients with heart failure and chronic kidney diseases. New agents for managing hyperkalemia may alter the long-term management of heart failure and the hypertension, proteinuria, and further function loss in chronic kidney diseases. In this jointly sponsored effort between the American Society of Hypertension and the National Kidney Foundation, 3 panels of researchers and practitioners from various disciplines discussed and summarized current understanding of the role of potassium in health and disease, focusing on cardiovascular, nutritional, and kidney considerations associated with both hypo- and hyperkalemia.
Collapse
Affiliation(s)
| | | | - Morgan E Grams
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lisa Gutekunst
- Suburban Dialysis, Williamsville, NY; Davita, Inc, Denver, CO
| | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX; The Heart Hospital, Plano, TX
| | - Biff F Palmer
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
23
|
Kovesdy CP, Appel LJ, Grams ME, Gutekunst L, McCullough PA, Palmer BF, Pitt B, Sica DA, Townsend RR. Potassium Homeostasis in Health and Disease: A Scientific Workshop Cosponsored by the National Kidney Foundation and the American Society of Hypertension. Am J Kidney Dis 2017; 70:844-858. [PMID: 29029808 DOI: 10.1053/j.ajkd.2017.09.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 09/08/2017] [Indexed: 12/31/2022]
Abstract
While much emphasis, and some controversy, centers on recommendations for sodium intake, there has been considerably less interest in recommendations for dietary potassium intake, in both the general population and patients with medical conditions, particularly acute and chronic kidney disease. Physiology literature and cohort studies have noted that the relative balance in sodium and potassium intakes is an important determinant of many of the sodium-related outcomes. A noteworthy characteristic of potassium in clinical medicine is the extreme concern shared by many practitioners when confronted by a patient with hyperkalemia. Fear of this often asymptomatic finding limits enthusiasm for recommending potassium intake and often limits the use of renin-angiotensin-aldosterone system blockers in patients with heart failure and chronic kidney diseases. New agents for managing hyperkalemia may alter the long-term management of heart failure and the hypertension, proteinuria, and further function loss in chronic kidney diseases. In this jointly sponsored effort between the American Society of Hypertension and the National Kidney Foundation, 3 panels of researchers and practitioners from various disciplines discussed and summarized current understanding of the role of potassium in health and disease, focusing on cardiovascular, nutritional, and kidney considerations associated with both hypo- and hyperkalemia.
Collapse
Affiliation(s)
| | | | - Morgan E Grams
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lisa Gutekunst
- Suburban Dialysis, Williamsville, NY; Davita, Inc, Denver, CO
| | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX; The Heart Hospital, Plano, TX
| | - Biff F Palmer
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
24
|
Kuo HL, Liu YL, Liang CC, Chang CT, Wang SM, Liu JH, Lin HH, Wang IK, Yang YF, Chou CY, Huang CC. Prolonged QT interval is linked to all-cause and cardiac mortality in chronic peritoneal dialysis patients. Nephrology (Carlton) 2017; 22:436-440. [PMID: 27149688 DOI: 10.1111/nep.12808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Huey-Liang Kuo
- Graduate Institute of Clinical Medical Science, College of Medicine; China Medical University; Taichung Taiwan
- Kidney Institute and Division of Nephrology, Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Yao-Lung Liu
- Kidney Institute and Division of Nephrology, Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Chih-Chia Liang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
| | - Chiz-Tzung Chang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Su-Ming Wang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Jiung-Hsiun Liu
- Kidney Institute and Division of Nephrology, Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Hsin-Hung Lin
- Kidney Institute and Division of Nephrology, Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - I-Kuan Wang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Ya-Fei Yang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Che-Yi Chou
- Kidney Institute and Division of Nephrology, Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - Chiu-Ching Huang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| |
Collapse
|
25
|
Genovesi S, Porcu L, Luise MC, Riva H, Nava E, Contaldo G, Stella A, Pozzi C, Ondei P, Minoretti C, Gallieni M, Pontoriero G, Conte F, Torri V, Bertoli S, Vincenti A. Sudden Death in End Stage Renal Disease: Comparing Hemodialysis versus Peritoneal Dialysis. Blood Purif 2017; 44:77-88. [PMID: 28365692 DOI: 10.1159/000464347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/18/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIMS This study aimed to evaluate total and sudden death (SD) in a cohort of dialysis patients, comparing hemodialysis (HD) vs. peritoneal dialysis (PD). METHODS This is a multicenter retrospective cohort study. RESULTS Deaths were 626 out of 1,823 in HD and 62 of 249 in PD patients. HD patients had a greater number of comorbidities (p < 0.05). PD patients had a lower risk of death than HD patients (p < 0.001); however, the advantage decreased with time (p < 0.001). Mortality predictors were left ventricular ejection fraction (LVEF) ≤35%, older age, ischemic heart disease, diabetes mellitus, previous stroke, and atrial fibrillation (p < 0.03). SDs were 84:71 in HD and 13 in PD population (12.1 and 22.8% of all causes of death, respectively). A non-significant risk of SD among PD compared to HD patients was detected. SD predictors were older age, ischemic heart disease, and LVEF ≤35% (p < 0.05). CONCLUSIONS HD patients showed a greater presence of comorbidities and reduced survival compared to PD patients; however, the incidence of SD does not differ in the 2 populations. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=464347.
Collapse
|
26
|
Abstract
Dialysate composition is a critical aspect of the hemodialysis prescription. Despite this, trial data are almost entirely lacking to help guide the optimal dialysate composition. Often, the concentrations of key components are chosen intuitively, and dialysate composition may be determined by default based on dialysate manufacturer specifications or hemodialysis facility practices. In this review, we examine the current epidemiological evidence guiding selection of dialysate bicarbonate, calcium, magnesium, and potassium, and identify unresolved issues for which pragmatic clinical trials are needed.
Collapse
Affiliation(s)
- Rita L McGill
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Daniel E Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
27
|
Sabzghabaei F, Heydariezade SA, Joodat RS. The effects of different electrolyte composition in dialysate on QTc interval; a controlled trial. J Renal Inj Prev 2016; 5:153-6. [PMID: 27689113 PMCID: PMC5040003 DOI: 10.15171/jrip.2016.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/05/2016] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Hemodialysis (HD) has impact on the cardiovascular system by inducing changes in the characteristics of body fluids such as PH, temperature and electrolyte concentrations. In the previous studies, prolongation of the QT interval and increase of QT dispersion have been reported during HD sessions. These changes were more significant while using solutions with less potassium and higher bicarbonate during dialysis. OBJECTIVES The aim of our study was to investigate the effects of different potassium and bicarbonate concentrations on electrocardiography (ECG) parameters and the electrochemical balance of cell membranes. PATIENTS AND METHODS This is a double blind controlled clinical trial with crossover design. This interventional study has been conducted on 36 patients over 18 years who undergoing HD 3 times a week for at least 6 months. Twelve-lead ECG has been obtained before starting and one hour after end of each HD session. The QTc was measured and changes recorded by a cardiologist. Correlations were evaluated by univariate regression analysis. RESULTS 54.38 years (16 to 77 years), 66.7% were male. No significant increase in QT interval has been seen while dialyzing with 2 meq/l potassium and 24 meq/l bicarbonate, 2 meq/l potassium and 28 meq/l bicarbonate and 3 meq/l potassium and 24 meq/l bicarbonate beside high calcium (2.5 meq/l) dialysate was conducted. Age, gender, serum calcium and serum bicarbonate level before HD session did not influence the mean QT intervals before and after dialysis. CONCLUSION Concentration of potassium beside moderate dose of bicarbonate in dialysis bath had not any significant influence on QT intervals after dialysis.
Collapse
Affiliation(s)
- Foroogh Sabzghabaei
- Department of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Rashin S Joodat
- Department of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
28
|
Abstract
PURPOSE OF REVIEW Although the overall mortality rate of patients with end-stage renal disease in the United States continues to decline, cardiac complications remain a leading cause of death in this population. The purpose of this review is to identify principles that can be used to optimize the dialysate concentration of electrolytes in order to reduce the incidence of sudden cardiac deaths (SCDs). RECENT FINDINGS The ratio of observed to expected SCD is 1.71 in the 12 h following the onset of a hemodialysis session. A dialysate potassium concentration of less than 2 mEq/l has been associated with an increased risk of SCD as has a dialysate calcium less than 2.5 mEq/l and an elevated serum to dialysate calcium gradient. Midweek predialysis serum bicarbonate concentrations that are less than 22 or more than 27 mEq/l have been associated with increased mortality. An elevated predialysis serum bicarbonate may be a sign of the malnutrition inflammation complex syndrome. Magnesium has not been well studied in hemodialysis patients. SUMMARY Dialysate content plays an important role in the risk of SCD in hemodialysis patients on hemodialysis. There is a need for further studies designed to identify patients at risk and to determine what strategies can be used to lower this risk.
Collapse
|
29
|
Burdette S, Roppolo LP, Green W, Shinthia N, Ye P, Hynan LS. The Effect of Antiemetics and Antihistamines on the QTc Interval in Emergent Dialysis Patients With Baseline QTc Prolongation. J Emerg Med 2016; 51:99-105. [PMID: 27614302 DOI: 10.1016/j.jemermed.2016.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/02/2016] [Accepted: 04/20/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Unfunded patients with end-stage renal disease (ESRD) who do not have routinely scheduled hemodialysis often receive medications known to prolong the QTc interval for their uremic symptoms even though they may have pre-existing QTc prolongation. OBJECTIVES The purpose of this study was to determine the effects of these medications on the QTc interval in these patients. METHODS Unfunded patients with ESRD presenting to the emergency department (ED) for emergent hemodialysis (HD) with QTc prolongation on their initial electrocardiogram (ECG) were recruited. Approximately 2 hours after receiving an antihistamine or antiemetic, a second ECG was ordered and the QTc was measured. The patients were followed-up 1 week later. RESULTS Twenty-nine percent (44/152) of the unfunded patients with ESRD presenting for HD at a county hospital had QT prolongation and were included with 107 total ED visits during the 4-week study period. The mean QTc was 483.7 msec on presentation to the ED, and the mean QTc measured 2 hours after receiving an antihistamine or antiemetic was 483.8 msec. None of the patients were admitted for life-threatening dysrhythmias. Thirty-six percent (16/44) of the recruited patients had QTc intervals >500 msec with a combined total of 31 patient visits, of which only 25.8% (8/31) had an increase in the QTc interval after an antihistamine or antiemetic medication was given. None of these patients had adverse outcomes, such a dysrhythmia or death, at 1-week follow-up. CONCLUSION This study shows that medications known to cause QTc prolongation are safe to use in therapeutic doses in patients with ESRD who have pre-existing QT prolongation. Few patients in this cohort had significantly prolonged QTc intervals at baseline.
Collapse
Affiliation(s)
- Scott Burdette
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Lynn P Roppolo
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Walter Green
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Nashid Shinthia
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Peter Ye
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Linda S Hynan
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| |
Collapse
|
30
|
Abstract
OBJECTIVES There is no evidence regarding the effect of ondansetron on the QT interval in pediatric patients in the ICU. This study aimed to describe the effect of ondansetron on the corrected QT interval in patients cared for in the PICU. DESIGN Retrospective cohort, consecutive enrollment study. SETTING Single-center, tertiary-level, medical/surgical PICU. PATIENTS All patients less than 8 years old who received ondansetron over an 11-month period were included. Exclusion criteria were atrial arrhythmia, bundle-branch block, known congenital long QT syndrome, and concomitant administration of proarrhythmic antiarrhythmic agents. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Overall, 210 doses of ondansetron were administered to 107 patients, with a mean age 10.5 ± 4.8 years; 49% were men. Corrected QT interval increased to 460-500 ms in 29% and to more than 500 ms in 11% of events of ondansetron administration. The mean baseline corrected QT interval even before ondansetron administration was higher for these groups (460-500 and > 500 ms; 457 ± 33 and 469 ± 45, respectively; p ≤ 0.05). In multivariate analysis, both groups were associated significantly with underlying electrolyte abnormalities (odds ratio, 2.2; 95% CI, 1.1-4.4 and odds ratio, 5.1; 95% CI, 1.8-15.7, respectively); the group with corrected QT interval more than 500 ms was also significantly associated with organ dysfunction (odds ratio, 3.2; 95% CI, 1.1-9.4). As the numbers of risk factors increased from only ondansetron to three additional QT aggravating factors (electrolyte abnormalities, administration of other QT-prolonging drugs, and organ dysfunction), the likelihood of being associated with corrected QT interval more than 500 ms increased. CONCLUSIONS Prolonged QT interval is observed commonly in PICUs following the administration of ondansetron. Underlying risk factors, such as electrolyte abnormalities and organ dysfunction, seem to pose the highest risk of prolongation of QT interval in these patients. The awareness of prevalent risk factors for increased corrected QT interval may help identify patients at high risk for arrhythmias.
Collapse
|
31
|
Di Lullo L, Rivera R, Barbera V, Bellasi A, Cozzolino M, Russo D, De Pascalis A, Banerjee D, Floccari F, Ronco C. Sudden cardiac death and chronic kidney disease: From pathophysiology to treatment strategies. Int J Cardiol 2016; 217:16-27. [PMID: 27174593 DOI: 10.1016/j.ijcard.2016.04.170] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/27/2016] [Accepted: 04/30/2016] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) patients demonstrate higher rates of cardiovascular mortality and morbidity; and increased incidence of sudden cardiac death (SCD) with declining kidney failure. Coronary artery disease (CAD) associated risk factors are the major determinants of SCD in the general population. However, current evidence suggests that in CKD patients, traditional cardiovascular risk factors may play a lesser role. Complex relationships between CKD-specific risk factors, structural heart disease, and ventricular arrhythmias (VA) contribute to the high risk of SCD. In dialysis patients, the occurrence of VA and SCD could be exacerbated by electrolyte shifts, divalent ion abnormalities, sympathetic overactivity, inflammation and iron toxicity. As outcomes in CKD patients after cardiac arrest are poor, primary and secondary prevention of SCD and cardiac arrest could reduce cardiovascular mortality in patients with CKD.
Collapse
Affiliation(s)
- L Di Lullo
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy.
| | - R Rivera
- Division of Nephrology, S. Gerardo Hospital, Monza, Italy
| | - V Barbera
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy
| | - A Bellasi
- Department of Nephrology and Dialysis, S. Anna Hospital, Como, Italy
| | - M Cozzolino
- Department of Health Sciences, Renal Division, San Paolo Hospital, University of Milan, Italy
| | - D Russo
- Division of Nephrology, University of Naples "Federico II", Naples, Italy
| | - A De Pascalis
- Department of Nephrology and Dialysis, Vito Fazzi Hospital, Lecce, Italy
| | - D Banerjee
- Consultant Nephrologist and Reader, Clinical Sub Dean, Renal and Transplantation Unit, St George's University, London, UK
| | - F Floccari
- Department of Nephrology and Dialysis, S. Paolo Hospital, Civitavecchia, Italy
| | - C Ronco
- International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
| |
Collapse
|
32
|
Kovesdy CP. Epidemiology of hyperkalemia: an update. Kidney Int Suppl (2011) 2016; 6:3-6. [PMID: 30675413 DOI: 10.1016/j.kisu.2016.01.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 01/13/2023] Open
Abstract
Hyperkalemia represents one of the most important acute electrolyte abnormalities, due to its potential for causing life-threatening arrhythmias. In individuals with normal kidney function hyperkalemia occurs relatively infrequently, but it can be much more common in patients who have certain predisposing conditions. Patients with chronic kidney disease are the most severely affected group, by virtue of their decreased ability to excrete potassium and because they commonly have additional predisposing conditions that often cluster within patients with chronic kidney disease. These conditions include comorbidities (e.g., diabetes mellitus) and the use of various medications, of which the most important are renin-angiotensin-aldosterone system inhibitors (RAASis). Hyperkalemia is associated with increased risk for all-cause mortality and for malignant arrhythmias such as ventricular fibrillation. The increased risk for adverse outcomes is observed even in serum potassium ranges that are often not considered targets for therapeutic interventions. The heightened risk of mortality associated with hyperkalemia is present in all patient populations, even those in whom hyperkalemia occurs otherwise rarely, such as individuals with normal kidney function.
Collapse
Affiliation(s)
- Csaba P Kovesdy
- University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA
| |
Collapse
|
33
|
Luque Y, Bataille A, Taldir G, Rondeau É, Ridel C. [Cardiac arrest in dialysis patients: Risk factors, preventive measures and management in 2015]. Nephrol Ther 2015; 12:6-17. [PMID: 26547563 DOI: 10.1016/j.nephro.2015.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 02/06/2023]
Abstract
Patients undergoing hemodialysis have a 10 to 20 times higher risk of sudden cardiac arrest (SCA) than the general population. Sudden cardiac death is a rare event (approximately 1 event per 10,000 sessions) but has a very high mortality rate. Epidemiological data comes almost exclusively from North American studies; there is a great lack of European data on the subject. Ventricular arrhythmia is the main mechanism of sudden cardiac deaths in dialysis patients. These patients develop increased sensitivity mainly due to a high prevalence of severe ischemic heart disease and left ventricular hypertrophy and to a frequent trigger event: electrolytic and plasma volume shifts during dialysis sessions. Unfortunately, accurate predictive markers of SCA do not exist, however some primary prevention trials using beta-blockers or angiotensin II receptor blockers are encouraging, while the use of implantable cardioverter defibrillators in the population of chronic dialysis patients remains controversial. Identification of patients at risk, minimizing trigger events such as electrolytic shifts and improving team skills in the diagnosis and initial resuscitation with the latest recommendations from 2010 seem necessary to reduce incidence and improve survival in this high risk population. Organization of European studies would also allow a more accurate view of this reality in our dialysis units.
Collapse
Affiliation(s)
- Yosu Luque
- Service des urgences néphrologiques et de transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75571 Paris cedex 20, France; Inserm UMR S 1155, bâtiment recherche, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
| | - Aurélien Bataille
- Département d'anesthésie-réanimation, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Inserm UMR S 1155, bâtiment recherche, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Guillaume Taldir
- Service de cardiologie, centre hospitalier de Saint-Brieuc, 22027 Saint-Brieuc cedex 1, France
| | - Éric Rondeau
- Service des urgences néphrologiques et de transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75571 Paris cedex 20, France; Inserm UMR S 1155, bâtiment recherche, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Sorbonne universités, UPMC université Paris 06, 4, place Jussieu, 75005 Paris, France
| | - Christophe Ridel
- Service dialyse et aphérèse Aura Paris Plaisance, 185A, rue Raymond-Losserand, 75014 Paris, France
| |
Collapse
|
34
|
Yamada S, Ueki K, Tokumoto M, Suehiro T, Kimura H, Taniguchi M, Fujimi S, Kitazono T, Tsuruya K. Effects of Lowering Dialysate Calcium Concentration on Mineral and Bone Disorders in Chronic Hemodialysis Patients: Conversion from 3.0 mEq/L to 2.75 mEq/L. Ther Apher Dial 2015; 20:31-9. [DOI: 10.1111/1744-9987.12329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shunsuke Yamada
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
- Department of Internal Medicine; Fukuoka Dental College; Fukuoka Japan
| | - Kenji Ueki
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Masanori Tokumoto
- Department of Internal Medicine; Fukuoka Dental College; Fukuoka Japan
| | - Takaichi Suehiro
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Hiroshi Kimura
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
- Fukuoka Renal Clinic; Fukuoka Japan
| | - Masatomo Taniguchi
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | | | - Takanari Kitazono
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
- Department of Integrated Therapy for Chronic Kidney Disease; Graduate School of Medical Sciences, Kyushu University; Fukuoka Japan
| |
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW The optimal dialysate calcium concentration (DCC) in hemodialysis patients is still debated. Strategies have varied over time due to developments in the treatments available for mineral metabolism disorders and our increasing knowledge of bone and vascular diseases. International recommendations [Kidney Disease Outcomes Quality Initiative (KDIGO) and European Best Practice Guidelines] urge for DCC individualization in order to meet the patient's specific needs whenever possible. In this review, we aim to discuss the pros and cons of individualizing the DCC in hemodialysis patients. RECENT FINDINGS Different regions of the world have various strategies with respect to DCCs. Decreasing the DCC slightly reduces calcemia, but mainly stimulates parathyroid hormone secretion and bone turnover. Conversely, increasing the DCC increases calcemia slightly and reduces parathyroid hormone secretion and bone turnover markedly. Furthermore, higher DCCs favor hemodynamic stability and can prevent ventricular arrhythmias. The impact of DCC individualization on survival rate or cardiovascular calcification progression has not been evaluated. SUMMARY Individualizing DCC appears to be useful but requires time, a clear defined strategy, and close biological monitoring. Even though some studies have shown that using individualized DCCs of 1.25 or 1.75 mmol/l is not harmful, the real benefits of this strategy need to be assessed in a large, multicentric trial.
Collapse
|
36
|
Abstract
Sudden cardiac death (SCD) accounts for a quarter of all deaths in end-stage renal disease (ESRD) patients. While causative mechanisms of SCD in this high risk population remain poorly defined, interaction of the vulnerable myocardium with dialysis-related arrhythmic triggers is thought to play a major role. Recent evidence suggests that dialysis-induced derangement of calcium concentrations contributes to the increased risk of all-cause and cardiovascular mortality, vascular calcification, and SCD. Current KDIGO guidelines recommend avoiding high dialysate calcium concentrations as a precaution against adverse outcomes of increased calcium burden and vascular calcification. Conversely, low calcium concentration is also implicated in the development of SCD via increased QT dispersion and prolonged QT interval. Consequently, the optimal dialysate calcium concentration in dialysis patients remains debated and further studies are needed to establish the best strategy for managing calcium in dialysis patients.
Collapse
Affiliation(s)
- Esther D Kim
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Rulan S Parekh
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children and the University Health Network, Toronto, Ontario, Canada.,Department of Pediatrics and Medicine, School of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
37
|
Langote A, Ahearn M, Zimmerman D. Dialysate Calcium Concentration, Mineral Metabolism Disorders, and Cardiovascular Disease: Deciding the Hemodialysis Bath. Am J Kidney Dis 2015; 66:348-58. [PMID: 25958080 DOI: 10.1053/j.ajkd.2015.02.336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/04/2015] [Indexed: 11/11/2022]
Abstract
Patients with end-stage kidney disease treated with dialysis are at increased risk to experience fractures and cardiovascular events than similar-aged people from the general population. The enhanced risk for these outcomes in dialysis patients is not completely explained by traditional risk factors for osteoporosis and cardiovascular disease. Mineral metabolism abnormalities are almost universal by the time patients require dialysis therapy, with most patients having some type of renal osteodystrophy and vascular calcification. These abnormalities have been linked to adverse skeletal and cardiovascular events. However, it has become clear that the treatment regimens used to modify the serum calcium, phosphate, and parathyroid hormone levels almost certainly contribute to the poor outcomes for dialysis patients. In this article, we focus on one aspect of mineral metabolism management; dialysate calcium concentration and the relationships among dialysate calcium concentrations, mineral and bone disorder, and cardiovascular disease in hemodialysis patients.
Collapse
Affiliation(s)
- Amit Langote
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Micayla Ahearn
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Deborah Zimmerman
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| |
Collapse
|
38
|
Associates of cardiopulmonary arrest in the perihemodialytic period. Int J Nephrol 2014; 2014:961978. [PMID: 25530881 PMCID: PMC4235586 DOI: 10.1155/2014/961978] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022] Open
Abstract
Cardiopulmonary arrest during and proximate to hemodialysis is rare but highly fatal. Studies have examined peridialytic sudden cardiac event risk factors, but no study has considered associates of cardiopulmonary arrests (fatal and nonfatal events including cardiac and respiratory causes). This study was designed to elucidate patient and procedural factors associated with peridialytic cardiopulmonary arrest. Data for this case-control study were taken from the hemodialysis population at Fresenius Medical Care, North America. 924 in-center cardiopulmonary events (cases) and 75,538 controls were identified. Cases and controls were 1 : 5 matched on age, sex, race, and diabetes. Predictors of cardiopulmonary arrest were considered for logistic model inclusion. Missed treatments due to hospitalization, lower body mass, coronary artery disease, heart failure, lower albumin and hemoglobin, lower dialysate potassium, higher serum calcium, greater erythropoietin stimulating agent dose, and normalized protein catabolic rate (J-shaped) were associated with peridialytic cardiopulmonary arrest. Of these, lower albumin, hemoglobin, and body mass index; higher erythropoietin stimulating agent dose; and greater missed sessions had the strongest associations with outcome. Patient health markers and procedural factors are associated with peridialytic cardiopulmonary arrest. In addition to optimizing nutritional status, it may be prudent to limit exposure to low dialysate potassium (<2 K bath) and to use the lowest effective erythropoietin stimulating agent dose.
Collapse
|
39
|
Khaledifar A, Momeni A, Hasanzadeh K, Amiri M, Sedehi M. Association of Corrected QT and QT Dispersion with Echocardiographic and Laboratory Findings in Uremic Patients under Chronic Hemodialysis. J Cardiovasc Echogr 2014; 24:78-82. [PMID: 28465910 PMCID: PMC5353447 DOI: 10.4103/2211-4122.143972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Cardiovascular disease is the most common cause of mortality in dialysis patients. Chronic renal failure and hemodialysis (HD) patients may have longer corrected QT (QTc) interval compared with the normal population. Long QTc interval may be a predictor of ventricular arrhythmia and cardiovascular mortality in these patients and hence the aim of this study was the evaluation of the relationship between QTc interval and some echocardiographic findings and laboratory exam results in HD patients. Materials and Methods: In a cross-sectional study, 60 HD patients with age >18 years and the dialysis duration >3 months were enrolled. Blood samples were taken, and electrocardiography and echocardiography were done before the dialysis session in the patients. Results: Mean age of the patients was 56.15 ± 14.6 years. QTc interval of the patients was 0.441 ± 0.056 s and QT dispersion (QTd) was 64.17 ± 25.93 ms. There was no statistically significant relationship between QTc interval and QTd with duration of dialysis, body mass index, age, and gender (P > 0.05). There was also no significant relationship between QTc interval and QTd with mitral regurgitation, tricuspid regurgitation and aortic insufficiency (P > 0.05). In addition, QTc interval and QTd of the patients had not any correlation with serum parathormon and serum Ca, K, HCO3 (P > 0.05). Conclusion: Based on our results, in HD patients, QTc interval and QTd were not correlated with echocardiographic findings or laboratory exam results. Therefore, it can be concluded that QTc interval prolongation probably has not any correlation with cardiac mortality of the HD patients.
Collapse
Affiliation(s)
- Arsalan Khaledifar
- Department of Internal Medicine, Nephrology Division, Shahrekord University of Medical Sciences, Iran
| | - Ali Momeni
- Department of Internal Medicine, Nephrology Division, Shahrekord University of Medical Sciences, Iran
| | - Katayoun Hasanzadeh
- Department of Internal Medicine, Nephrology Division, Shahrekord University of Medical Sciences, Iran
| | - Masoud Amiri
- Department of Epidemiology and Biostatistics, Social Health Determinants Research Center, Shahrekord University of Medical Sciences, Iran
| | - Morteza Sedehi
- Department of Biostatistics and Epidemiology, School of Health, Shahrekord University of Medical Sciences, Iran
| |
Collapse
|
40
|
Laboratory markers of ventricular arrhythmia risk in renal failure. BIOMED RESEARCH INTERNATIONAL 2014; 2014:509204. [PMID: 24982887 PMCID: PMC4058221 DOI: 10.1155/2014/509204] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 01/01/2023]
Abstract
Sudden cardiac death continues to be a major public health problem. Ventricular arrhythmia is a main cause of sudden cardiac death. The present review addresses the links between renal function tests, several laboratory markers, and ventricular arrhythmia risk in patients with renal disease, undergoing or not hemodialysis or renal transplant, focusing on recent clinical studies. Therapy of hypokalemia, hypocalcemia, and hypomagnesemia should be an emergency and performed simultaneously under electrocardiographic monitoring in patients with renal failure. Serum phosphates and iron, PTH level, renal function, hemoglobin and hematocrit, pH, inflammatory markers, proteinuria and microalbuminuria, and osmolarity should be monitored, besides standard 12-lead ECG, in order to prevent ventricular arrhythmia and sudden cardiac death.
Collapse
|
41
|
Moledina D, Geller D. Is low dialysate potassium ever indicated in outpatient hemodialysis? Semin Dial 2014; 27:263-5. [PMID: 24635442 DOI: 10.1111/sdi.12212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Dennis Moledina
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | | |
Collapse
|
42
|
Nocturnal Home Hemodialysis Associates with Improvement of Electrocardiographic Features Linked to Sudden Cardiac Death. ASAIO J 2014; 60:99-105. [DOI: 10.1097/mat.0000000000000023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
43
|
Chen HC, Lim LM, Chang JM, Misra M. Save life and improve quality: report from the 5th Congress of International Society for Hemodialysis. Hemodial Int 2013; 18:163-71. [PMID: 23899054 DOI: 10.1111/hdi.12068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The 5th congress of International Society for Hemodialysis took place last August 3-5, 2012 at the Grand Hotel in Taipei and focused on "Save Life and Improve Quality." It attracted a total of 927 participants from 18 countries. The full spectrum of hemodialysis was covered with plenary lectures and symposiums delivered by experts from different subspecialties in nephrology starting from the history of hemodialysis, mineral bone disease, microinflammation and advanced techniques in hemodialysis. It was followed by critical care in nephrology, anemia, and nutrition in dialysis. Last but not the least, natural disasters and medical economics in hemodialysis were also discussed extensively. This special article will highlight the authentic contributions and innovative clinical presentations from the meeting.
Collapse
Affiliation(s)
- Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | |
Collapse
|
44
|
Nagy N, Acsai K, Kormos A, Sebők Z, Farkas AS, Jost N, Nánási PP, Papp JG, Varró A, Tóth A. [Ca2+]i-induced augmentation of the inward rectifier potassium current (IK1) in canine and human ventricular myocardium. Pflugers Arch 2013; 465:1621-35. [DOI: 10.1007/s00424-013-1309-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/07/2013] [Accepted: 06/07/2013] [Indexed: 11/30/2022]
|
45
|
GAO ZHUO, LUN LIDE, LI XINLUN. Low calcium dialysate combined with CaCO 3 in hyperphosphatemia in hemodialysis patients. Exp Ther Med 2013; 5:1732-1736. [PMID: 23837063 PMCID: PMC3702715 DOI: 10.3892/etm.2013.1067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 03/20/2013] [Indexed: 01/24/2023] Open
Abstract
This aim of this study was to observe the effects of the application of low calcium dialysate (LCD) combined with oral administration of CaCO3 in the treatment of hyperphosphatemia, as well as blood Ca2+, calcium-phosphate product (CPP), parathyroid hormone (PTH) and blood pressure in patients undergoing hemodialysis. Thirty-one maintenance hemodialysis (MHD) patients with hyperphosphatemia, but normal blood Ca2+, underwent dialysis with an initial dialy-sate Ca2+ concentration (DCa) of 1.50 mmol/l for six months and then with 1.25 mmol/l for six months. The patients who underwent dialysis with a DCa of 1.25 mmol/l were treated orally with 0.3 g CaCO3 tablets three times a day. In the third and sixth months [observation end point (OEP)] of the dialysis, the concentrations of Ca2+, phosphorus and intact PTH (iPTH) were measured; blood pressure and side-effects prior to and following dialysis were also observed. The Ca2+, CPP and iPTH levels increased (P<0.05) in the sixth month of treatment with a DCa of 1.50 mmol/l. However, the Ca2+ concentration declined to a certain degree, CPPs decreased significantly (P<0.05) and the iPTH concentration increased following treatment with a DCa of 1.25 mmol/l for six months. The incidence rate of adverse effects of LCD was 12.9% (4/31); the effects were mainly muscle spasms, hypotension and elevated PTH. The periodic application of LCD combined with the oral administration of CaCO3 effectively reduced serum phosphorus and CPPs among MHD patients with hyperphosphatemia, indicating that the treatment may be used clinically.
Collapse
Affiliation(s)
- ZHUO GAO
- Department of Nephrology, Air Force General Hospital, Beijing 100142,
P.R. China
| | - LI-DE LUN
- Department of Nephrology, Air Force General Hospital, Beijing 100142,
P.R. China
| | - XIN-LUN LI
- Department of Nephrology, Air Force General Hospital, Beijing 100142,
P.R. China
| |
Collapse
|
46
|
Bleyer AJ. Clinical Implications of the Relationship between Low Calcium Concentration Dialysate and Sudden Death. Clin J Am Soc Nephrol 2013; 8:706-7. [DOI: 10.2215/cjn.03130313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
47
|
Jean G, Lataillade D, Genet L, Legrand E, Kuentz F, Moreau-Gaudry X, Fouque D. Les concentrations élevées du calcium du dialysat ne sont pas associées à la mortalité chez les patients hémodialysés : les résultats de l’étude ARNOS. Nephrol Ther 2013; 9:103-7. [DOI: 10.1016/j.nephro.2012.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 08/13/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
|
48
|
Pun PH, Horton JR, Middleton JP. Dialysate calcium concentration and the risk of sudden cardiac arrest in hemodialysis patients. Clin J Am Soc Nephrol 2013; 8:797-803. [PMID: 23371957 DOI: 10.2215/cjn.10000912] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The optimal dialysate calcium concentration to maintain normal mineralization and reduce risk of cardiovascular events in hemodialysis patients is debated. Guidelines suggest that dialysate Ca concentration should be lowered to avoid vascular calcification, but cardiac arrhythmias may be more likely to occur at lower dialysate Ca. Concurrent use of QT-prolonging medications may also exacerbate arrhythmic risk. This study examined the influence of serum Ca, dialysate Ca, and QT interval-prolonging medications on the risk of sudden cardiac arrest in a cohort of hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This case-control study among 43,200 hemodialysis patients occurred between 2002 and 2005; 510 patients who experienced a witnessed sudden cardiac arrest were compared with 1560 matched controls. This study examined covariate-adjusted sudden cardiac arrest risk associations with serum Ca, dialysate Ca, serum dialysate Ca gradient, and prescription of QT-prolonging medications using logistic regression techniques. RESULTS Patients assigned to low Ca dialysate<2.5 mEq/L were more likely to be exposed to larger serum dialysate Ca gradient and had a greater fall in BP during dialysis treatment. After accounting for covariates and baseline differences, low Ca dialysate<2.5 mEq/L (odds ratio=2.00, 95% confidence interval=1.40-2.90), higher corrected serum Ca (odds ratio=1.10, 95% confidence interval=1.00-1.30), and increasing serum dialysate Ca gradient (odds ratio=1.40, 95% confidence interval=1.10-1.80) were associated with increased risk of sudden cardiac arrest, whereas there were no significant risk associations with QT-prolonging medications. CONCLUSIONS Increased risk of sudden cardiac arrest associated with low Ca dialysate and large serum dialysate Ca gradients should be considered in determining the optimal dialysate Ca prescription.
Collapse
Affiliation(s)
- Patrick H Pun
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina 27710, USA.
| | | | | |
Collapse
|
49
|
Di Iorio B, Bellasi A. QT interval in CKD and haemodialysis patients. Clin Kidney J 2013; 6:137-43. [PMID: 26019841 PMCID: PMC4432438 DOI: 10.1093/ckj/sfs183] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 12/14/2012] [Indexed: 01/22/2023] Open
Abstract
Cardiovascular (CV) disease is the leading cause of morbidity and mortality in chronic kidney disease (CKD) patients. Although about half of the deaths are due to CV causes, only a minority are directly linked to myocardial infarction and it is estimated that cardiac arrest or cardiac arrhythmias account for about a quarter of all deaths registered in dialysis patients. Thus, simple non-invasive tools such as electrocardiogram (ECG) may detect those patients at increased risk for arrhythmias. The QT interval on the standard 12-lead ECG is the time from ventricular depolarization (Q wave onset) to cardiac repolarization completion (end of the T wave) and represents a marker of cardiac repolarization defects. Numerous studies suggest a direct association between QT abnormalities and poor prognosis in the general population, CKD patients and dialysis patients. Of note, multivariable adjustments for different traditional and CKD-specific risk factors for CV events attenuate but do not cancel these associations. We herein review the clinical significance of simple non-invasive tools such as the QT tract on ECG for detecting those patients at increased risk of CV event and possibly for treatment individualization.
Collapse
Affiliation(s)
- Biagio Di Iorio
- UOC of Nephrology , 'A Landolfi' Hospital , Solofra ( AV ), Italy
| | | |
Collapse
|
50
|
Genovesi S, Rossi E, Nava M, Riva H, De Franceschi S, Fabbrini P, Viganò MR, Pieruzzi F, Stella A, Valsecchi MG, Stramba-Badiale M. A case series of chronic haemodialysis patients: mortality, sudden death, and QT interval. ACTA ACUST UNITED AC 2013; 15:1025-33. [DOI: 10.1093/europace/eus412] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|