Simonetta Genovesi1,2, Elisa Nava3, Chiara Bartolucci4, Stefano Severi4, Antonio Vincenti5, Gina Contaldo3, Giada Bigatti6, Daniele Ciurlino6, Silvio Volmer Bertoli6. 1. Department Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900, Monza, Italy. simonetta.genovesi@unimib.it. 2. Nephrology Unit, San Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy. simonetta.genovesi@unimib.it. 3. Department Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900, Monza, Italy. 4. Computational Physiopathology Unit Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Via dell'Università 50, 47522, Cesena, Italy. 5. Department of Cardiology, Ospedale San Giuseppe Multimedica, Via San Vittore 12, 20123, Milan, Italy. 6. Dialysis and Nephrology Unit, IRCCS Multimedica, Via Milanese 300, 20099, Sesto San Giovanni, Italy.
Abstract
BACKGROUND: Hemodialysis (HD) sessions induce changes in plasma electrolytes that lead to modifications of QT interval, virtually associated with dangerous arrhythmias. It is not known whether such a phenomenon occurs even during peritoneal dialysis (PD). The aim of the study is to analyze the relationship between dialysate and plasma electrolyte modifications and QT interval during a PD exchange. METHODS: In 15 patients, two manual PD 4-h exchanges were performed, using two isotonic solutions with different calcium concentration (Ca++1.25 and Ca1.75++ mmol/L). Dialysate and plasma electrolyte concentration and QT interval (ECG Holter recording) were monitored hourly. A computational model simulating the ventricular action potential during the exchange was also performed. RESULTS: Dialysis exchange induced a significant plasma alkalizing effect (p < 0.001). Plasma K+ significantly decreased at the third hour (p < 0.05). Plasma Na+ significantly decreased (p < 0.001), while plasma Ca++ slightly increased only when using the Ca 1.75++ mmol/L solution (p < 0.01). The PD exchange did not induce modifications of clinical relevance in the QT interval, while a significant decrease in heart rate (p < 0.001) was observed. The changes in plasma K+ values were significantly inversely correlated to QT interval modifications (p < 0.001), indicating that even small decreases of K+ were consistently paralleled by small QT prolongations. These results were perfectly confirmed by the computational model. CONCLUSIONS: The PD exchange guarantees a greater cardiac electrical stability compared to the HD session and should be preferred in patients with a higher arrhythmic risk. Moreover, our study shows that ventricular repolarization is extremely sensitive to plasma K+ changes, also in normal range.
BACKGROUND: Hemodialysis (HD) sessions induce changes in plasma electrolytes that lead to modifications of QT interval, virtually associated with dangerous arrhythmias. It is not known whether such a phenomenon occurs even during peritoneal dialysis (PD). The aim of the study is to analyze the relationship between dialysate and plasma electrolyte modifications and QT interval during a PD exchange. METHODS: In 15 patients, two manual PD 4-h exchanges were performed, using two isotonic solutions with different calcium concentration (Ca++1.25 and Ca1.75++ mmol/L). Dialysate and plasma electrolyte concentration and QT interval (ECG Holter recording) were monitored hourly. A computational model simulating the ventricular action potential during the exchange was also performed. RESULTS: Dialysis exchange induced a significant plasma alkalizing effect (p < 0.001). Plasma K+ significantly decreased at the third hour (p < 0.05). Plasma Na+ significantly decreased (p < 0.001), while plasma Ca++ slightly increased only when using the Ca 1.75++ mmol/L solution (p < 0.01). The PD exchange did not induce modifications of clinical relevance in the QT interval, while a significant decrease in heart rate (p < 0.001) was observed. The changes in plasma K+ values were significantly inversely correlated to QT interval modifications (p < 0.001), indicating that even small decreases of K+ were consistently paralleled by small QT prolongations. These results were perfectly confirmed by the computational model. CONCLUSIONS: The PD exchange guarantees a greater cardiac electrical stability compared to the HD session and should be preferred in patients with a higher arrhythmic risk. Moreover, our study shows that ventricular repolarization is extremely sensitive to plasma K+ changes, also in normal range.
Authors: Stefano Severi; Daniela Pogliani; Giulia Fantini; Paolo Fabbrini; Maria Rosa Viganò; Eleonora Galbiati; Giuseppe Bonforte; Antonio Vincenti; Andrea Stella; Simonetta Genovesi Journal: Europace Date: 2010-02-25 Impact factor: 5.214
Authors: Karlien J Ter Meulen; Ben J M Hermans; Frank M van der Sande; Bernard Canaud; Constantijn J A M Konings; Jeroen P Kooman; Tammo Delhaas Journal: Sci Rep Date: 2021-05-10 Impact factor: 4.379
Authors: Irena Andršová; Katerina Hnatkova; Martina Šišáková; Ondřej Toman; Peter Smetana; Katharina M Huster; Petra Barthel; Tomáš Novotný; Georg Schmidt; Marek Malik Journal: Sci Rep Date: 2021-07-12 Impact factor: 4.996