Potassium Profiling in Hemodialysis
Main Article Content
Keywords
arrhythmia, dialysate potassium, potassium profiling, potassium removal, sudden cardiac death
Abstract
Cardiac dysrhythmia and sudden death account for a large proportion of cardiac mortality in dialysis patients. Risk factors for sudden death that are specific to dialysis patients include fluid and electrolyte imbalances during hemodialysis, particularly those of potassium. The risk of arrhythmia may be related to changes in serum K+ concentration during dialysis, and thus close attention should be paid to the dialysate K+ concentration and the serum–dialysate concentration gradient. Potassium profiling is a technique where the dialysate K+ concentration is gradually reduced to keep the gradient between blood and dialysate at a non-fluctuating low level. We provide a review of studies that compare constant potassium concentration in dialysate to gradual reduction in dialysate potassium concentration. These studies illustrate that adequate and more gradual potassium removal can be achieved with potassium profiling techniques, while having lower cardiac irritability.
References
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15. Tarif N, Yamani H, Bakhsh AJ, Al-Wakeel JS, Sulaimani F, Memon NA, et al. Electrocardiography and serum potassium before and after hemodialysis sessions. Saudi J Kidney Dis Transpl. 2008;19(1):47–53.
16. Kovesdy CP, Regidor DL, Mehrotra R, Jing J, McAllister CJ, Greenland S, et al. Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clin J Am Soc Nephrol. 2007;2(5):999–1007. https://doi.org/10.2215/CJN.04451206
17. Karnik JA, Young BS, Lew NL, Herget M, Dubinsky C, Lazarus JM, et al. Cardiac arrest and sudden death in dialysis units. Kidney Int. 2001;60(1):350–7. https://doi.org/10.1046/j.1523-1755.2001.00806.x
18. Jadoul M, Thumma J, Fuller D, Tentori F, Li Y, Morgenstern H, et al. Modifiable practices associated with sudden death among hemodialysis patients in the dialysis outcomes and practice patterns study. Clin J Am Soc Nephro. 2012;7(5):765–74. https://doi.org/10.2215/CJN.08850811
19. Morrison G, Michelson EL, Brown S, Morganroth J. Mechanism and prevention of cardiac arrhythmias in chronic hemodialysis patients. Kidney Int. 1980;17(6):811–19. https://doi.org/10.1038/ki.1980.93
20. Ebel H, Saure B, Laage CH, Dittmar A, Keuchel M, Stellwaag M. Influence of computer-modulated profile haemodialysis on cardiac arrhythmias. Nephrol Dial Transplant. 1990;5:165–6. https://doi.org/10.1093/ndt/5.suppl_1.165
21. Redaelli B, Locatelli F, Limido D, Andrulli S, Signorini MG, Sforzini S, et al. Effect of a new model of hemodialysis potassium removal on the control of ventricular arrhythmias. Kidney Int. 1996;50:609–17. https://doi.org/10.1038/ki.1996.356
22. Santoro A, Mancini E, Gaggi R, Cavalcanti S, Severi S, Cagnoli L, et al. Electrophysiological response to dialysis: The role of dialysate potassium content and profiling. Contrib Nephrol. 2005;149:295–305. https://doi.org/10.1159/000085691
23. Severi S, Vecchietti S, Cavalcanti S, Mancini E, Santoro A. Electrocardiographic changes during hemodiafiltration with different potassium removal rates. Blood Purif. 2003;21(6):381–8. https://doi.org/10.1159/000073440
24. Santoro A, Mancini E, London G, Mercadal L, Fessy H, Perrone B, et al. Patients with complex arrhythmias during and after haemodialysis suffer from different regimens of potassium removal. Nephrol Dial Transplant. 2008;23(4):1415–21.
25. Santoro A, Mancini E, Fontanazzi F, Paolini F. Potassium profiling in acetate-free biofiltration. Contrib Nephrol. 2002;137(137):260–7. https://doi.org/10.1159/000060222
26. Buemi M, Aloisi E, Coppolino G, Loddo S, Crascì E, Aloisi C, et al. The effect of two different protocols of potassium haemodiafiltration on QT dispersion. Nephrol Dial Transplant. 2005;20(6):1148–54. https://doi.org/10.1093/ndt/gfh770
27. Muñoz RI, Montenegro J, Salcedo A, Gallardo I, Martínez I, Quintanilla N, et al. Effect of acetate-free biofiltration with a potassium-profiled dialysate on the control of cardiac arrhythmias in patients at risk: a pilot study. Hemodial Int. 2008;12(1):108–13. https://doi.org/10.1111/j.1542-4758.2008.00250.x
28. Karaboyas A, Zee J, Brunelli SM, Usvyat LA, Weiner DE, Maddux FW, et al. Dialysate potassium, serum potassium, mortality, and arrhythmia events in hemodialysis: Results from the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis. 2017; 69(2);266–77. https://doi.org/10.1053/j.ajkd.2016.09.015
2. Saravanan P, Davidson NC. Risk assessment for sudden cardiac death in dialysis patients. Circ Arrhythmia Electrophysiol. 2010;3(5):553–9.
3. Genovesi S, Rivera R, Fabbrini P, Dossi C, Bonforte G, Mircoli L, et al. Dynamic QT interval analysis in uraemic patients receiving chronic haemodialysis. J Hypertens. 2003;21(10):1921–6. https://doi.org/10.1097/00004872-200310000-00020
4. Morris ST, Galiatsou E, Stewart GA, Rodger RS, Jardine AG. QT dispersion before and after hemodialysis. J Am Soc Nephrol. 1999;10(1):160–3.
5. Malhis M, Al-Bitar S, Farhood S, Zaiat KA. Changes in QT intervals in patients with end-stage renal disease before and after hemodialysis. Saudi J Kidney Dis Transpl. 2010;21(3):460–5.
6. Floccari F, Aloisi E, Nostro L, Caccamo C, Crisafulli A, Barillà A, et al. QTc interval and QTc dispersion during haemodiafiltration. Nephrology. 2004;9(6):335–40. https://doi.org/10.1111/j.1440-1797.2004.00333.x
7. Lorincz I, Mátyus J, Zilahi Z, Kun C, Karányi Z, Kakuk G. QT dispersion in patients with end-stage renal failure and during hemodialysis. J Am Soc Nephrol. 1999;10(6):1297–302.
8. Howse M, Sastry S, Bell G. Changes in the corrected QT interval and corrected QT dispersion during haemodialysis. Postgrad Med J. 2002;78:273–5. https://doi.org/10.1136/pmj.78.919.273
9. Shapira OM, Bar-Khayim Y. ECG changes and cardiac arrhythmias in chronic renal failure patients on hemodialysis. J Electrocardiol. 1992;25(4):273–9. https://doi.org/10.1016/0022-0736(92)90032-U
10. Hasan-Ali H, Maghraby MH, Mosad E, Abd-Elsayed AA. Pattern and possible contributing factors to dialysis-associated arrhythmia in young patients. East Mediterr Heal J. 2009;15(5):1313–22.
11. Nakamura S, Ogata C, Aihara N, Sasaki O, Yoshihara F, Nakahama H, et al. QTc dispersion in haemodialysis patients with cardiac complications. Nephrology (Carlton). 2005;10(2):113–18. https://doi.org/10.1111/j.1440-1797.2005.00362.x
12. Beaubien ER, Pylypchuk GB, Akhtar J, Jay Biem H. Value of corrected QT interval dispersion in identifying patients initiating dialysis at increased risk of total and cardiovascular mortality. Am J Kidney Dis. 2002;39(4):834–42. https://doi.org/10.1053/ajkd.2002.32005
13. Cupisti A, Galetta F, Caprioli R, Morelli E, Tintori GC, Franzoni F, et al. Potassium removal increases the QTc interval dispersion during hemodialysis. Nephron. 1999;82(2):122–6. https://doi.org/10.1159/000045387
14. Yetkin E, Ileri M, Tando?an I, Boran M, Yanik A, Hisar I, et al. Increased QT interval dispersion after hemodialysis: Role of peridialytic electrolyte gradients. Angiology. 2000;51(6):499–504. https://doi.org/10.1177/000331970005100607
15. Tarif N, Yamani H, Bakhsh AJ, Al-Wakeel JS, Sulaimani F, Memon NA, et al. Electrocardiography and serum potassium before and after hemodialysis sessions. Saudi J Kidney Dis Transpl. 2008;19(1):47–53.
16. Kovesdy CP, Regidor DL, Mehrotra R, Jing J, McAllister CJ, Greenland S, et al. Serum and dialysate potassium concentrations and survival in hemodialysis patients. Clin J Am Soc Nephrol. 2007;2(5):999–1007. https://doi.org/10.2215/CJN.04451206
17. Karnik JA, Young BS, Lew NL, Herget M, Dubinsky C, Lazarus JM, et al. Cardiac arrest and sudden death in dialysis units. Kidney Int. 2001;60(1):350–7. https://doi.org/10.1046/j.1523-1755.2001.00806.x
18. Jadoul M, Thumma J, Fuller D, Tentori F, Li Y, Morgenstern H, et al. Modifiable practices associated with sudden death among hemodialysis patients in the dialysis outcomes and practice patterns study. Clin J Am Soc Nephro. 2012;7(5):765–74. https://doi.org/10.2215/CJN.08850811
19. Morrison G, Michelson EL, Brown S, Morganroth J. Mechanism and prevention of cardiac arrhythmias in chronic hemodialysis patients. Kidney Int. 1980;17(6):811–19. https://doi.org/10.1038/ki.1980.93
20. Ebel H, Saure B, Laage CH, Dittmar A, Keuchel M, Stellwaag M. Influence of computer-modulated profile haemodialysis on cardiac arrhythmias. Nephrol Dial Transplant. 1990;5:165–6. https://doi.org/10.1093/ndt/5.suppl_1.165
21. Redaelli B, Locatelli F, Limido D, Andrulli S, Signorini MG, Sforzini S, et al. Effect of a new model of hemodialysis potassium removal on the control of ventricular arrhythmias. Kidney Int. 1996;50:609–17. https://doi.org/10.1038/ki.1996.356
22. Santoro A, Mancini E, Gaggi R, Cavalcanti S, Severi S, Cagnoli L, et al. Electrophysiological response to dialysis: The role of dialysate potassium content and profiling. Contrib Nephrol. 2005;149:295–305. https://doi.org/10.1159/000085691
23. Severi S, Vecchietti S, Cavalcanti S, Mancini E, Santoro A. Electrocardiographic changes during hemodiafiltration with different potassium removal rates. Blood Purif. 2003;21(6):381–8. https://doi.org/10.1159/000073440
24. Santoro A, Mancini E, London G, Mercadal L, Fessy H, Perrone B, et al. Patients with complex arrhythmias during and after haemodialysis suffer from different regimens of potassium removal. Nephrol Dial Transplant. 2008;23(4):1415–21.
25. Santoro A, Mancini E, Fontanazzi F, Paolini F. Potassium profiling in acetate-free biofiltration. Contrib Nephrol. 2002;137(137):260–7. https://doi.org/10.1159/000060222
26. Buemi M, Aloisi E, Coppolino G, Loddo S, Crascì E, Aloisi C, et al. The effect of two different protocols of potassium haemodiafiltration on QT dispersion. Nephrol Dial Transplant. 2005;20(6):1148–54. https://doi.org/10.1093/ndt/gfh770
27. Muñoz RI, Montenegro J, Salcedo A, Gallardo I, Martínez I, Quintanilla N, et al. Effect of acetate-free biofiltration with a potassium-profiled dialysate on the control of cardiac arrhythmias in patients at risk: a pilot study. Hemodial Int. 2008;12(1):108–13. https://doi.org/10.1111/j.1542-4758.2008.00250.x
28. Karaboyas A, Zee J, Brunelli SM, Usvyat LA, Weiner DE, Maddux FW, et al. Dialysate potassium, serum potassium, mortality, and arrhythmia events in hemodialysis: Results from the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis. 2017; 69(2);266–77. https://doi.org/10.1053/j.ajkd.2016.09.015
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Published
Aug 7, 2018
Article Details
How to Cite
Potassium Profiling in Hemodialysis. (2018). Journal of Renal and Hepatic Disorders, 2(2), 6-9. https://doi.org/10.15586/jrenhep.2018.34
Section
Review Nephrology
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