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Acute effect of a peritoneal dialysis exchange on electrolyte concentration and QT interval in uraemic patients.
Genovesi, Simonetta; Nava, Elisa; Bartolucci, Chiara; Severi, Stefano; Vincenti, Antonio; Contaldo, Gina; Bigatti, Giada; Ciurlino, Daniele; Bertoli, Silvio Volmer.
Afiliación
  • Genovesi S; Department Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900, Monza, Italy. simonetta.genovesi@unimib.it.
  • Nava E; Nephrology Unit, San Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy. simonetta.genovesi@unimib.it.
  • Bartolucci C; Department Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900, Monza, Italy.
  • Severi S; Computational Physiopathology Unit Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Via dell'Università 50, 47522, Cesena, Italy.
  • Vincenti A; Computational Physiopathology Unit Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Via dell'Università 50, 47522, Cesena, Italy.
  • Contaldo G; Department of Cardiology, Ospedale San Giuseppe Multimedica, Via San Vittore 12, 20123, Milan, Italy.
  • Bigatti G; Department Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, 20900, Monza, Italy.
  • Ciurlino D; Dialysis and Nephrology Unit, IRCCS Multimedica, Via Milanese 300, 20099, Sesto San Giovanni, Italy.
  • Bertoli SV; Dialysis and Nephrology Unit, IRCCS Multimedica, Via Milanese 300, 20099, Sesto San Giovanni, Italy.
Clin Exp Nephrol ; 23(11): 1315-1322, 2019 Nov.
Article en En | MEDLINE | ID: mdl-31423549
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Uremia / Diálisis Peritoneal / Electrólitos / Fallo Renal Crónico Tipo de estudio: Etiology_studies / Guideline / Prognostic_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Exp Nephrol Asunto de la revista: NEFROLOGIA Año: 2019 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Japón
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Uremia / Diálisis Peritoneal / Electrólitos / Fallo Renal Crónico Tipo de estudio: Etiology_studies / Guideline / Prognostic_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Exp Nephrol Asunto de la revista: NEFROLOGIA Año: 2019 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Japón