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. 2021 Apr;2(4):695-707.
doi: 10.34067/KID.0007452020. Epub 2021 Apr 29.

Electrolyte Changes in Contemporary Hemodialysis: A Secondary Analysis of the Monitoring in Dialysis (MiD) Study

Simon Correa  1   2 , Katherine Mikovna Scovner  1   2 , James A Tumlin  3 , Prabir Roy-Chaudhury  4   5 , Bruce A Koplan  6 , Alexandru I Costea  7 , Vijay Kher  8 , Don Williamson  9 , Saurabh Pokhariyal  10 , Candace K McClure  11 , Finnian R Mc Causland  1   2 , David M Charytan  12 ; MiD Investigators and Committees; MiD Investigators and Committees
Affiliations

Electrolyte Changes in Contemporary Hemodialysis: A Secondary Analysis of the Monitoring in Dialysis (MiD) Study

Simon Correa et al. Kidney360. 2021 Apr.

Abstract

Background: There is a paucity of contemporary data examining electrolyte changes during and immediately after hemodialysis (HD), and their relationship with dialysate prescriptions. The present study examines these relationships.

Methods: We analyzed patient- (n=66) and HD session-level pre- and post-dialysis laboratory data (n=1,713) over a six-month period from the Monitoring in Dialysis Study. We fit mixed effects regression models to analyze electrolyte, blood urea nitrogen, creatinine, and albumin levels immediately post-HD, accounting for pre-HD and dialysate prescriptions. In a subset of US patients (n=40), 15-minute post-HD and 30-minute post-HD values were available at one session. Predictive models were fit to estimate electrolyte levels immediately post-HD, accounting for pre-HD concentrations and dialysate prescriptions.

Results: Serum bicarbonate, calcium, and albumin increased (mean increase 4.9±0.3 mEq/L, 0.7±0.1 mEq/L, and 0.4±0.03 g/dL, respectively), whereas potassium, magnesium, and phosphorus decreased immediately post-HD (mean -1.2±0.1 mEq/L, -0.3±0.03 mEq/L, and -3.0±0.2 mg/dL, respectively). Hypokalemia and hypophosphatemia were present in 40% of and 67% of immediate post-HD samples, respectively. Dynamic changes were observed in electrolyte concentrations at 15- and 30-minutes post-HD, compared to immediately post-HD.

Conclusion: We describe the magnitude of post-dialytic changes in serum electrolytes with contemporary HD, reporting a high incidence of electrolyte abnormalities post-HD, and present predictive nomograms relating electrolyte changes immediately post-HD to dialysate prescriptions. Our results may be useful for clinical care and provide insights for future research on dialysate prescriptions.

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Conflict of interest statement

The MiD study was conducted by the MiD Investigators, funded by Medtronic, and designed by Medtronic in collaboration with an advisory committee that included the authors. D.M. Charytan participated in the MiD study as investigator and advisory committee member; reports receiving expert witness fees related to dialysate composition from Fresenius; reports receiving research support from Amgen and Medtronic; reports receiving research support and consulting fees related to services as national investigator, trial steering committee or Data Monitoring Committee of Allena Pharmaceuticals, AstraZeneca (modest), Janssen Pharmaceuticals, Gilead Pharmaceuticals, Novo Nordisk, and Zoll Medical; and reports receiving consulting fees and travel support from Amgen, AstraZeneca, Daichi Sankyo, Fresenius (modest), GlaxoSmithKline, Medtronic/Covidien, and Merck. A.I. Costea reports receiving speaker's bureau for Biotronik and Biosense Webster. V. Kher reports receiving research funding from Astellas India, Novartis India, and Sanofi Aventis India; reports receiving honoraria from Astellas India, Novartis India, Roche India, Torrent, and Reddy's India; reports being a scientific advisor for Biocon India, Medtronic, Novartis India, Reddy's India, Roche India, Sanofi Aventis, and Torrent India; reports receiving speakers bureau from Biocon India, Intas India, Medtronic, Novartis India, Panacea India Roche India, Pfizer, and Sanofi Aventis India. P. Roy-Chaudhury reports being a consultant or on the advisory board of Akebia, Bayer, BD-Bard, Cormedix, Humacyte, Medtronic, WL Gore, and Vifor-Relypsa. D. Williamson reports being COO for American Renal Associates. All remaining authors have nothing to disclose.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Serum electrolyte and laboratory parameter changes over time. HD, hemodialysis; min, minute.
Figure 2.
Figure 2.
Predicted change in (A) serum sodium, (B) serum potassium, (C) serum bicarbonate, and (D) serum calcium according to baseline serum electrolyte and dialysate prescription (mEq/L). Each graph is on the basis of a model that adjusted for the prehemodialysis (HD) concentration of the electrolyte of interest. For instance, the predictive graph for serum sodium is adjusted for pre-HD serum sodium.
See this image and copyright information in PMC

References

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