[Cardiac arrhythmias in patients with renal insufficiency treated with periodic hemodialysis]

A Santoro, C Basile
Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia 2006, 23 (6): 552-9
Despite substantial progress in dialysis technology, cardiovascular disease remain the sole major cause of death in chronic dialysis patients. Nearly half of deaths on chronic maintenance hemodialysis are secondary to myocardial infarction, cardiac arrest, malignant arrhythmias and other cardiac causes. In fact, diabetes, anemia, hyperparathyroidism, and hypertension wide prevalence among chronic dialysis patients foster structural heart diseases. Moreover fluid overload and metabolic abnormalities such as metabolic acidosis, dyskalemia, dysmagnesemia lead to an increased risk of clinically significant ventricular arrhythmias and sudden cardiac death. During dialysis patients show a non-homogeneous repolarization through an increase in Q-T duration and Q-T dispersion. The dialysis-related sudden variation in extra-cellular potassium, calcium and pH levels may be contributing factors to the genesis of an electrical disequilibrium in myocardial cells. One of the potential therapeutic options is, in fact, adjusting the dialysis bath. The K profiling with non-constant K concentration in the dialysate, but with high concentration in the first hour of dialysis and progressive reduction until the end of the session, seems very promising in reducing the arrhythmic risk in cardiomyopathy patients.

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