Cardiac Arrhythmia During Early-Week and Mid-Week Dialysis in Hemodialysis Patients.

Abstract

Data on cardiac arrhythmia and electrolyte changes during the dialysis cycle has been limited. Fifty-two hemodialysis(HD) patients underwent 48-hour Holter monitoring during early-week and mid-week HD sessions. Pre-HD and post-HD blood samples were collected in both HD sessions. The 48-hour Holter data were divided into 5 phases: 1) 4-hour during the early-week HD(HD1), 2) 12-hour post-HD1, 3) 16-hour period between phase 2 and 4 (used as the patient s baseline ECG), 4) 12-hour pre-HD2 phase, and 5) 4-hour during the mid-week HD(HD2). The patients mean age was 68.54±13.37\u2009years. We found that the dialysate-to-serum[K] gradient and changes of S[K] were significantly higher in HD1 than in HD2, as well as changes of S[Mg]. There were no significant ECG changes during the 4-hour HD1 and HD2 when compared with the baseline ECG. Phase 2 of Holter ECG was the most common phase that showed significant changes (increased QTc dispersion, increased ventricular events, increased number of PVCs, ST elevation and ST depression), which was contributed from the dialysate[K] 2\u2009mmol/L subgroup, but not the dialysate[K] 3\u2009mmol/L subgroup. In the subgroup of patients with a high UFR (mean UFR ≥10 ml/kg/hr), there were significantly increased ventricular events and ST-segment changes in phase 2. In conclusion, ECG changes were associated with the dialysis cycle, significantly in the 12-hour after early-week HD sessions. These may be associated with low dialysate[K] or high dialysate-to-S[K] gradient, high ultrafiltration rate and duration of the interdialytic interval. This article is protected by copyright. All rights reserved.