Kidney Week

Abstract: TH-PO266

The Association of Dialysate Bicarbonate with Cardiac Arrhythmia in the Monitoring in Dialysis (MiD) Study

Session Information

• Hemodialysis: Volume, Metabolic Complications, Clinical Outcomes
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Ravi, Katherine Scovner, Brigham and Women's Hospital, Boston, Massachusetts, United States

Katherine Scovner Ravi,

• Tumlin, James A., NephroNet Clinical Research Consortium, Atlanta, Georgia, United States

James A. Tumlin,

• Roy-Chaudhury, Prabir, UNC Kidney Center, Chapel Hill, NC and WG (Bill) Hefner VA Medical Center, Salisbury, North Carolina, United States

Prabir Roy-Chaudhury,

• Charytan, David M., New York University School of Medicine and NYU Langone Medical Center, New York, New York, United States

David M. Charytan,

• McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States

Finnian R. McCausland,

Group or Team Name

• Monitoring in Dialysis Study Group.

Background

Sudden death accounts for half of all cardiovascular-related mortality among patients receiving maintenance hemodialysis (HD) and occurs more frequently on days that patients undergo HD. Higher dialysate bicarbonate (D_BIC) may predispose to alkalemia and arrhythmogenesis. We tested if higher D_BIC is associated with cardiac arrhythmia, and if this is modified by serum bicarbonate (S_BIC).

Methods

Using data from the Monitoring in Dialysis study, we analyzed session-level data over a 12-month period from 66 patients with implantable loop recorders (ILR). We fit logistic regression and negative binomial mixed effects regression models to assess the association of D_BIC with the presence and frequency of reviewer confirmed arrhythmia (RCA) events (ILR identified or patient marked event in which a manual review of the stored ECG tracing confirmed the presence of atrial fibrillation, supraventricular tachycardia, sinus tachycardia with rate >130 beats per minute, ventricular tachycardia, asystole, or bradycardia) in the intra- and inter-dialytic period.

Results

Mean age was 56 ± 12 years, 70% were male, 53% were Black, and 35% were Asian. There were 9,718 RCA events over 3,655 HD sessions. There were fewer RCA episodes associated with D_BIC >35 compared to 35 mEq/L in unadjusted and adjusted models (IRR 0.45 (0.27, 0.75) and aIRR 0.54 (0.30, 0.97), respectively). Otherwise no associations between D_BIC and arrhythmia were identified. No results were modified by the inclusion of S_BIC in the model.

Conclusion

We observed a lower frequency of RCA with higher D_BIC, contrary to our original hypothesis. Within RCA, a majority of events were atrial arrhythmia. Validation of these findings in larger studies is required, with further need for interventional studies to explore the optimal D_BIC level.

Funding

• NIDDK Support