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.
Highlights
Mortality and morbidity in End Stage Renal Disease (ESRD) patients on hemodialysis (HD) remains high, and higher than non-dialysis patients with similar co-morbidity burden [1]
There are no standard practices for dialysate potassium concentrations and no recommendation has been provided in the NKF-KDOQI (National Kidney Foundation–Kidney Disease Outcomes Quality Initiative) cardiovascular disease guideline
In a large international cohort of HD patients, dialysate potassium concentration varied among clinical practices and countries and ranged anywhere from 1 meq/L to 3 meq/L [28]
Summary
Mortality and morbidity in End Stage Renal Disease (ESRD) patients on hemodialysis (HD) remains high, and higher than non-dialysis patients with similar co-morbidity burden [1]. Most of the evidence linking the risk of arrhythmia to dialysis is derived from Electrocardiogram (EKG) markers such as ventricular repolarization indices which include QT duration (QTc), QT dispersion (QTd), PCA-T (principal component analysis of T wave), and E1-T (first eigenvalue of T wave) [3,4,5,6,7,8,9,10,11] These indices are known to reflect increased risk of arrhythmia [11, 12] and one of the factors which has been shown to change these indices is the change in serum potassium, stemming from the critical role of the K+ ion in myocardial repolarization [6, 13,14,15]. Both hypokalemia and hyperkalemia have been shown to have associations with higher mortality in HD patients [16]
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