Effect of citric-acid dialysate on the QTC-interval

Karlien J Ter Meulen,Frank M Van Der Sande,Bernard Canaud,Tammo Delhaas,Ben J M Hermans,Jeroen P Kooman,Constantijn J A M Konings

doi:10.1038/s41598-021-89083-w

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.

Highlights

Lower dialysate calcium concentration and dialysate citric-acidification may positively affect calcification propensity in serum of haemodialysis (HD) patients
The PACE study suggested that predialysis low serum potassium (K) and ionized calcium are associated with higher risk prolongation of heart rate-corrected QT-intervals (QTc
We studied the influence of conventional Bic dialysis combined with acetate-acid with dialysate calcium (dCa) 1.50 mmol/l (A1.5), dCa 1.25 mmol/l (A1.25) and dCit with dCa 1.50 mmol/l (C1.5) on QT-interval corrected for heart rate (QTc) during the complete dialysis sessions

Summary

Introduction

Lower dialysate calcium (dCa) concentration and dialysate citric-acidification may positively affect calcification propensity in serum of haemodialysis (HD) patients. 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. Lower dialysate calcium concentrations (dCa) may positively affect the calcification tendency in serum of haemodialysis (HD) p atients, it may potentially have a prolonging effect on cardiac action p otential. A continuous QTc monitoring during acetate-free biofiltration with hemodiafiltration (HDF) session with different dCa (1.25 mM/l, 2 mM/L and profiled Ca) showed increased QTc for the lower dCa17. We studied the influence of conventional Bic dialysis combined with acetate-acid with dCa 1.50 mmol/l (A1.5), dCa 1.25 mmol/l (A1.25) and dCit with dCa 1.50 mmol/l (C1.5) on QTc during the complete dialysis sessions. The hypothesis was that QTc would increase during HD with C1.5 as compared to A1.5

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