Abstract: PO1228
The Effect of Intradialytic Potassium and Magnesium Fluctuations on Cardiovascular Functioning in ESRD Patients Undergoing In-Center Hemodialysis
Session Information
- Hemodialysis and Frequent Dialysis - 4
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Chuu, Andy, Washington University in Saint Louis, Saint Louis, Missouri, United States
- Matzumura Umemoto, Gonzalo, Washington University in Saint Louis, Saint Louis, Missouri, United States
- Rauchman, Michael I., Saint Louis VA Medical Center John Cochran Division, Saint Louis, Missouri, United States
- O Brien, Frank J., Washington University in Saint Louis, Saint Louis, Missouri, United States
Background
Patients with ESRD receiving in-center hemodialysis (HD) have an age-adjusted rate of mortality 4 times the general population. Increased mortality has been attributed to fatal arrhythmias. Mechanisms and risk factors for this are unknown. It has been postulated that changes in serum levels of Potassium(K)/Magnesium(Mg) with HD contribute to arrhythmia generation. Limited data is available to guide personalization of K prescription of HD to reduce this risk. No data exists describing the serum changes in Mg pre-, intra-, and post-HD. We examine the correlation between electrolyte fluctuations, arrhythmia generation, and heart rate variability (HRV) in ESRD patients undergoing in-center HD.
Methods
Single center, prospective, cross-sectional pilot study. 25 patients enrolled to achieve an 80% power. Demographic data, dialysis vintage, and HD prescription were recorded. Arrhythmia data was collected by placement of Holter monitor prior to 1st weekly HD session and recorded continuously for 5 days ending at completion of 3rd weekly HD session. Serum samples were obtained at time intervals 30, 60, 90, and 120 minutes during 1st weekly HD session for electrolytes. Pre and Post HD serum electrolyte analysis occurred during all 3 treatments. Associations were examined by count regression utilizing Poisson or negative binomial methods.
Results
25 patients were included in data analysis. Mean age 63 and primarily African American (73%). 73% of individuals were dialyzed utilizing 2mmol/L. Ectopy data and serum potassium / magnesium data are summarized in Table 1.
Conclusion
There is a trend towards increased ectopy (particularly on HD day 1) and decreased HRV on HD days. There is a trend towards hypo-K post-HD after HD sessions 2 and 3. Serum Mg levels remained stable pre and post HD throughout all HD sessions. Data derived in this study will be utilized to guide a larger future study with the goal towards personalized HD treatments.
Results
| # Hypokalemia (n) | Mean Pre K (mmol/L)(std) | Mean Post K (mmol/L)(std) | Mean Pre Mg (mmol/L)(std) | Mean Post Mg (mmol/L)(std) | |
| HD Session 1 | 7 | 4.7 (0.6) | 3.4 (0.3) | 2.3 (0.3) | 1.9 (0.2) |
| HD Session 2 | 10 | 4.7 (0.4) | 3.3 (0.3) | 2.3 (0.2) | 1.9 (0.2) |
| HD Session 3 | 10 | 4.7 (0.5) | 3.4 (0.3) | 2.3 (0.2) | 1.9 (0.2) |
| HD Session 1 | Interdialytic Days | HD Session 2 & 3 (mean) | |||
| Mean Daily Ectopic Beats | 5781 | 2346 | 3630 |