Acute effect of a peritoneal dialysis exchange on electrolyte concentration and QT interval in uraemic patients

Simonetta Genovesi, Elisa Nava, Chiara Bartolucci, Stefano Severi, Antonio Vincenti, Gina Contaldo, Giada Bigatti, Daniele Ciurlino, Silvio Volmer Bertoli

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)1315-1322
Number of pages8
JournalClinical and Experimental Nephrology
Volume23
Issue number11
DOIs
Publication statusPublished - Nov 1 2019

Keywords

  • Arrhythmias
  • Computational model
  • Electrolytes
  • Peritoneal dialysis
  • QT interval

ASJC Scopus subject areas

  • Physiology
  • Nephrology
  • Physiology (medical)

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