ACETATE HEMODIALYSIS DOES NOT INCREASE THE FREQUENCY OF ARRHYTHMIA INHEMODIALYSIS-PATIENTS

Arrhythmia is one of the most important causes of mortality in patient s on hemodialysis and may develop due to cardiovascular diseases or fl uid-electrolyte or acid-base abnormalities. Previous studies have show n that acetate hemodialysis (AHD) increased the frequency of arrythmia . To evaluate the frequency and the causes of arrhythmias during AHD, we studied 33 randomly selected patients (25 male and 8 female, mean a ge of 45 +/- 18 years) who were under AHD (4 h, 3 times/week, mean dur ation of HD of 38 +/- 29 months) with the same Cuprophan membranes. Al l patients underwent a detailed echocardiographic evaluation during th e interdialytic period. Twenty-four hours of Holter monitoring was per formed starting from the onset of HD. Twelve lead electrocardiography (ECG) was obtained, and venous and arterial blood samples were drawn f or serum electrolytes, pH, and arterial blood gas measurements before and after HD. Serum magnesium and potassium levels dropped after AHD ( from 2.3 +/- 0.5 to 1.9 +/- 0.3 mEq/L and from 5 +/- 0.7 to 3.4 +/- 0. 4 mEq/L respectively, p < 0.001); on the other hand serum pH, bicarbon ate, sodium, and calcium levels were normalized. Electrocardiographic evaluation revealed significant lengthening of the QTc interval (from 433 +/- 42 to 464 +/- 43 ms, p < 0.001), which was thought to be relat ed to the decrease in serum magnesium and potassium levels. The freque ncies of ventricular premature contractions (VPCs) were not different during AHD and the interdialytic period (8 +/- 9.1 to 6.5 +/- 11 contr actions/h, p > 0.05). This was also true for supraventricular prematur e contractions (SVPCs) and supraventricular tachycardia (SVT). Nonsust ained ventricular tachycardia was observed in 2 patients during HD and in 1 patient in the interdialytic period. No relation was established between the echocardiographic findings and the frequency of arrhythmi a. In our ambulatory electrocardiographic study, the frequencies of VP Cs and SVPCs observed during the interdialytic period were only positi vely correlated with age (r = 0.54, p = 0.013 and r = 0.50, p = 0.010, respectively). No relation was found between the frequency of arrhyth mia and the gender of the patients; duration of HD; etiology of kidney disease; or serum Na, K, Ca, iCa, Mg, bicarbonate, or pH levels (p > 0.05). In conclusion, the application of AHD does not increase the fre quency of arrhythmia in HD patients as had been shown in previous stud ies.