Abstract :
[en] Background. Sudden death is frequent in haemodialysis (HD) patients. Both hyperkalaemia and change of plasma
potassium(K) concentrations induced by HD could explain this. The impact of increasing dialysate K by 1 mEq/L on plasma
K concentrations and electrocardiogram(ECG) results before and after HD sessions was studied.
Methods. Patients with pre-dialysis K>5.5 mEq/L were excluded. ECG and K measurements were obtained before and after
the first session of the week for 2 weeks. Then, K in the dialysate was increased (from 1 or 3 to 2 or 4 mEq/L, respectively).
Blood and ECG measurements were repeated after 2 weeks of this change.
Results. Twenty-seven prevalent HD patients were included. As expected, a significant decrease in K concentrations was
observed after the dialysis session, but this decrease was significantly lower after the switch to an increased dialysate K.
The pre-dialysis K concentrations were not different after changing, but post-dialysis K concentrations were higher after
switching (P<0.0001), with a lower incidence of post-dialysis hypokalaemia. Regarding ECG, before switching, the QT
interval (QT) dispersion increased during the session, whereas no difference was observed after switching. One week after
switching, post-dialysis QT dispersion [38 (34–42) ms] was lower than post-dialysis QT dispersion 2 weeks and 1 week
before switching [42 (38–57) ms, P¼0.0004; and 40 (35–50) ms, P¼0.0002].
Conclusions. A simple increase of 1 mEq/L of K in the dialysate is associated with a lower risk of hypokalaemia and a lower
QT dispersion after the dialysis session. Further study is needed to determine if such a strategy is associated with a lower
risk of sudden death.
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