Haemodynamic consequences of changing potassium concentrations in haemodialysis fluids.

Details

Serval ID
serval:BIB_7ECBD6BD56DF
Type
Article: article from journal or magazin.
Collection
Publications
Title
Haemodynamic consequences of changing potassium concentrations in haemodialysis fluids.
Journal
Bmc Nephrology
Author(s)
Gabutti L., Salvadé I., Lucchini B., Soldini D., Burnier M.
ISSN
1471-2369 (Electronic)
ISSN-L
1471-2369
Publication state
Published
Issued date
2011
Volume
12
Pages
14
Language
english
Notes
Publication types: Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
BACKGROUND: A rapid decrease of serum potassium concentrations during haemodialysis produces a significant increase in blood pressure parameters at the end of the session, even if effects on intra-dialysis pressure are not seen. Paradoxically, in animal models potassium is a vasodilator and decreases myocardial contractility. The purpose of this trial is to study the precise haemodynamic consequences induced by acute changes in potassium concentration during haemodialysis.
METHODS: In 24 patients, 288 dialysis sessions, using a randomised single blind crossover design, we compared six dialysate sequences with different potassium profiles. The dialysis sessions were divided into 3 tertiles, casually modulating potassium concentration in the dialysate between the value normally used K and the two cut-off points K+1 and K-1 mmol/l. Haemodynamics were evaluated in a non-invasive manner using a finger beat-to-beat monitor.
RESULTS: Comparing K-1 and K+1, differences were found within the tertiles regarding systolic (+5.3, +6.6, +2.3 mmHg, p < 0.05, < 0.05, ns) and mean blood pressure (+4.3, +6.4, -0.5 mmHg, p < 0.01, < 0.01, ns), as well as peripheral resistance (+212, +253, -4 dyne.sec.cm-5, p < 0.05, < 0.05, ns). The stroke volume showed a non-statistically-significant inverse trend (-3.1, -5.2, -0.2 ml). 18 hypotension episodes were recorded during the course of the study. 72% with K-1, 11% with K and 17% with K+1 (p < 0.01 for comparison K-1 vs. K and K-1 vs. K+1).
CONCLUSIONS: A rapid decrease in the concentration of serum potassium during the initial stage of the dialysis-obtained by reducing the concentration of potassium in the dialysate-translated into a decrease of systolic and mean blood pressure mediated by a decrease in peripheral resistance. The risk of intra-dialysis hypotension inversely correlates to the potassium concentration in the dialysate.
TRIAL REGISTRATION NUMBER: NCT01224314.
Keywords
Blood Pressure/drug effects, Cross-Over Studies, Female, Hemodialysis Solutions/chemistry, Hemodialysis Solutions/pharmacology, Humans, Hypotension/physiopathology, Male, Potassium/blood, Potassium/pharmacology, Renal Dialysis/methods, Stroke Volume/drug effects, Vascular Resistance/drug effects
Pubmed
Open Access
Yes
Create date
24/07/2013 9:30
Last modification date
16/04/2020 5:26
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