Simon Correa1,2, Katherine Mikovna Scovner1,2, James A Tumlin3, Prabir Roy-Chaudhury4, Bruce A Koplan5, Alexandru I Costea6, Vijay Kher7, Don Williamson8, Saurabh Pokhariyal9, Candace K McClure10, Finnian R Mc Causland1,2, David M Charytan11,12. 1. Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. 2. Harvard Medical School, Boston, MA, USA. 3. NephroNet Clinical Research Consortium, Atlanta, Georgia, USA. 4. UNC Kidney Center, Chapel Hill, NC and WG (Bill) Hefner VA Medical Center, Salisbury, NC. 5. Cardiology Division, Department of Medicine, Brigham and Women's Hospital. 6. University of Cincinnati School of Medicine, Cincinnati, Ohio, USA. 7. Medanta Kidney & Urology Institute, Medanta The Medicity, India. 8. Southeastern Clinical Research Institute, Augusta, Georgia, USA. 9. Manipal Hospital, New Delhi, India. 10. NAMSA, Minneapolis, Minnesota, USA. 11. New York University School of Medicine and NYU Langone Medical Center, New York, NY. 12. See Appendix for list of investigators and committees.
Abstract
BACKGROUND: There is a paucity of contemporary data examining electrolyte changes during and immediately after hemodialysis (HD), and their relationship with dialysate prescriptions. The present study examines these relationships. METHODS: We analyzed patient- (n=66) and HD session-level pre- and post-dialysis laboratory data (n=1,713) over a six-month period from the Monitoring in Dialysis Study. We fit mixed effects regression models to analyze electrolyte, blood urea nitrogen, creatinine, and albumin levels immediately post-HD, accounting for pre-HD and dialysate prescriptions. In a subset of US patients (n=40), 15-minute post-HD and 30-minute post-HD values were available at one session. Predictive models were fit to estimate electrolyte levels immediately post-HD, accounting for pre-HD concentrations and dialysate prescriptions. RESULTS: Serum bicarbonate, calcium, and albumin increased (mean increase 4.9±0.3 mEq/L, 0.7±0.1 mEq/L, and 0.4±0.03 g/dL, respectively), whereas potassium, magnesium, and phosphorus decreased immediately post-HD (mean -1.2±0.1 mEq/L, -0.3±0.03 mEq/L, and -3.0±0.2 mg/dL, respectively). Hypokalemia and hypophosphatemia were present in 40% of and 67% of immediate post-HD samples, respectively. Dynamic changes were observed in electrolyte concentrations at 15- and 30-minutes post-HD, compared to immediately post-HD. CONCLUSION: We describe the magnitude of post-dialytic changes in serum electrolytes with contemporary HD, reporting a high incidence of electrolyte abnormalities post-HD, and present predictive nomograms relating electrolyte changes immediately post-HD to dialysate prescriptions. Our results may be useful for clinical care and provide insights for future research on dialysate prescriptions.
BACKGROUND: There is a paucity of contemporary data examining electrolyte changes during and immediately after hemodialysis (HD), and their relationship with dialysate prescriptions. The present study examines these relationships. METHODS: We analyzed patient- (n=66) and HD session-level pre- and post-dialysis laboratory data (n=1,713) over a six-month period from the Monitoring in Dialysis Study. We fit mixed effects regression models to analyze electrolyte, blood urea nitrogen, creatinine, and albumin levels immediately post-HD, accounting for pre-HD and dialysate prescriptions. In a subset of US patients (n=40), 15-minute post-HD and 30-minute post-HD values were available at one session. Predictive models were fit to estimate electrolyte levels immediately post-HD, accounting for pre-HD concentrations and dialysate prescriptions. RESULTS: Serum bicarbonate, calcium, and albumin increased (mean increase 4.9±0.3 mEq/L, 0.7±0.1 mEq/L, and 0.4±0.03 g/dL, respectively), whereas potassium, magnesium, and phosphorus decreased immediately post-HD (mean -1.2±0.1 mEq/L, -0.3±0.03 mEq/L, and -3.0±0.2 mg/dL, respectively). Hypokalemia and hypophosphatemia were present in 40% of and 67% of immediate post-HD samples, respectively. Dynamic changes were observed in electrolyte concentrations at 15- and 30-minutes post-HD, compared to immediately post-HD. CONCLUSION: We describe the magnitude of post-dialytic changes in serum electrolytes with contemporary HD, reporting a high incidence of electrolyte abnormalities post-HD, and present predictive nomograms relating electrolyte changes immediately post-HD to dialysate prescriptions. Our results may be useful for clinical care and provide insights for future research on dialysate prescriptions.
Authors: Eric W Young; Justin M Albert; Sudtida Satayathum; David A Goodkin; Ronald L Pisoni; Takashi Akiba; Tadao Akizawa; Kiyoshi Kurokawa; Jürgen Bommer; Luis Piera; Friedrich K Port Journal: Kidney Int Date: 2005-03 Impact factor: 10.612
Authors: David M Charytan; Robert Foley; Peter A McCullough; John D Rogers; Peter Zimetbaum; Charles A Herzog; James A Tumlin Journal: Clin J Am Soc Nephrol Date: 2016-01-13 Impact factor: 8.237
Authors: James A Tumlin; Prabir Roy-Chaudhury; Bruce A Koplan; Alexandru I Costea; Vijay Kher; Don Williamson; Saurabh Pokhariyal; David M Charytan Journal: BMC Nephrol Date: 2019-03-05 Impact factor: 2.388
Authors: Katherine Scovner Ravi; Caroline Espersen; Katherine A Curtis; Jonathan W Cunningham; Karola S Jering; Narayana G Prasad; Elke Platz; Finnian R Mc Causland Journal: Kidney360 Date: 2022-05-10