title: Dialysate and serum potassium in hemodialysis.
abstract: Most patients with end-stage renal disease depend on intermittent hemodialysis to maintain levels of serum potassium and other electrolytes within a normal range. However, one of the challenges has been the safety of using a low-potassium dialysate to achieve that goal, given the concern about the effects that rapid and/or large changes in serum potassium concentrations may have on cardiac electrophysiology and arrhythmia. Additionally, in this patient population, there is a high prevalence of structural cardiac changes and ischemic heart disease, making them even more susceptible to acute arrhythmogenic triggers. This concern is highlighted by the knowledge that about two-thirds of all cardiac deaths in dialysis are due to sudden cardiac death and that sudden cardiac death accounts for 25% of the overall death for end-stage renal disease. Developing new approaches and practice standards for potassium removal during dialysis, as well as understanding other modifiable triggers of sudden cardiac death, such as other electrolyte components of the dialysate (magnesium and calcium), rapid ultrafiltration rates, and safety of a number of medications (ie, drugs that prolong the QT interval or use of digoxin), are critical in order to decrease the unacceptably high cardiac mortality experienced by hemodialysis-dependent patients.
authors.affiliation: Veterans Administration Tennessee Valley Healthcare System, Nashville, TN; Vanderbilt University Medical Center, Nashville, TN. Electronic address: adriana.hung@vanderbilt.edu.
authors.forename: Adriana M
authors.initials: AM
authors.lastname: Hung
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Hakim
mesh_terms: D001741:Black or African American; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000139:chemically induced / Q000209:etiology / Q000517:prevention & control; D017963:Azithromycin / Q000009:adverse effects; D001639:Bicarbonates / Q000009:adverse effects; D002118:Calcium / Q000097:blood; D003326:Coronary Circulation; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D004347:Drug Interactions; D017809:Fatal Outcome; D015312:Hemodialysis Solutions / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry*; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications; D007008:Hypokalemia / Q000139:chemically induced* / Q000150:complications; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000209:etiology / Q000628:therapy; D008133:Long QT Syndrome / Q000139:chemically induced; D008274:Magnesium / Q000097:blood; D008297:Male; D009853:Omeprazole / Q000009:adverse effects; D011188:Potassium / Q000008:administration & dosage / Q000032:analysis* / Q000097:blood / Q000493:pharmacokinetics; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D006435:Renal Dialysis / Q000009:adverse effects*; D013997:Time Factors; D014462:Ultrafiltration
chemical_list: D001639:Bicarbonates; D015312:Hemodialysis Solutions; D054328:Proton Pump Inhibitors; D017963:Azithromycin; D008274:Magnesium; D009853:Omeprazole; D011188:Potassium; D002118:Calcium
keywords: Sudden cardiac death; dialysate; hemodialysis; low potassium dialysate; medication safety; review