Large potassium shifts during dialysis enhance cardiac repolarization instability
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TECHNICAL NOTE
Large potassium shifts during dialysis enhance cardiac repolarization instability Dominik Schüttler1,2,3 · Ulf Schönermarck4 · Felix Wenner1,2 · Marcell Toepfer5 · Konstantinos D. Rizas1,2 · Axel Bauer2,6 · Stefan Brunner1 · Wolfgang Hamm1,2 Received: 20 July 2020 / Accepted: 27 September 2020 © The Author(s) 2020
Abstract Background Patients with end-stage kidney disease are at high risk for the development of arrhythmias and sudden cardiac death (SCD). This has been especially attributed to large potassium shifts during hemodialysis (HD), and malignant arrhythmias are closely linked to dysfunction of the autonomic nervous system. Nevertheless, there is still a lack of methods for risk stratification in these patients. Methods In the present pilot study we investigated changes of the novel ECG-based biomarker periodic repolarization dynamics (PRD) mirroring the effect of efferent sympathetic nervous activity on the ventricular myocardium in 18 patients undergoing routine hemodialysis. High-resolution ECGs were recorded throughout the dialysis and PRD values were calculated out of 30 min intervals at the start and the end of dialysis. Results We detected a clear correlation between the intradialytic potassium shift and the increase in PRD levels (Spearman correlation coefficient R = 0.62, p = 0.006). Patients with a potassium shift > 1 mmol/l showed significantly increased levels of PRD at the end of dialysis when compared to patients with potassium shifts ≤ 1.0 mmol/l [delta PRD 2.82 (IQR 2.13) vs. − 2.08 (IQR 3.60), p = 0.006]. Spearman analysis showed no significant correlation between PRD changes and fluid removal (R = − 0.23, p = 0.36). Conclusions We provide evidence that large potassium shifts during HD enhance sympathetic activity-associated repolarization instability. This could facilitate the occurrence of malignant arrhythmias, and PRD measurements might serve as a non-invasive monitoring tool in HD patients in future. Keywords Autonomic dysfunction · Periodic repolarization dynamics · Dialysis · Potassium shift · Arrhythmia
Introduction Cardiovascular and renal diseases often coexist, and both contribute to a substantially high morbidity and mortality. Hemodialysis (HD) patients suffer from an estimated 14-fold Stefan Brunner and Wolfgang Hamm contributed equally to this study and share authorship. * Dominik Schüttler [email protected]‑muenchen.de 1
Medizinische Klinik Und Poliklinik I, Campus Grosshadern and Innenstadt, University Hospital Munich, LudwigMaximilians University Munich (LMU), Marchioninistraße 15, 81377 Munich, Germany
DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance (MHA), Partner Site Munich, Munich, Germany
2
increased mortality due to sudden cardiac death (SCD) compared to patients with normal kidney function. About one third of deaths in patients with end-stage kidney disease are related to SCD, mostly caused by malignant cardiac arrhythmias [1]. Aggressive removal of potassium and fluids resulting in large serum pota
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