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Effect of citric-acid dialysate on the QTC-interval

Karlien J Ter Meulen1,2, Ben J M Hermans3,4,5, Frank M van der Sande6

  • 1Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, PO Box 5800, 6202AZ, Maastricht, The Netherlands. karlien.ter.meulen@mumc.nl.

Scientific Reports
|May 11, 2021
PubMed

Insights

Lowering dialysate calcium and using citric acid in hemodialysis may affect cardiac rhythm. This study found that while both approaches slightly prolonged the corrected QT interval (QTc), the effect was limited in hemodialysis patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Biochemistry

Background:

  • Dialysate calcium concentration and acidification influence serum calcification propensity in hemodialysis patients.
  • Lower ionized blood calcium may increase the risk of cardiac arrhythmias due to prolonged action potentials.
  • Citric acid dialysate is explored as an alternative to acetic acid dialysate.

Purpose of the Study:

  • To investigate the effect of citric-acid dialysate on the corrected QT interval (QTc) in hemodialysis patients.
  • To compare QTc changes with conventional acetic-acid dialysate at different dialysate calcium concentrations.
  • To assess the potential pro-arrhythmic risk associated with altered dialysate composition.

Main Methods:

  • A four-week, multicenter, randomized cross-over trial.
  • Patients received either acetic-acid dialysate (1.50 or 1.25 mmol/l calcium) or citric-acid dialysate (1.50 mmol/l calcium).
  • Continuous electrocardiogram (ECG) monitoring was performed during specific dialysis sessions.

Main Results:

  • A significant, yet limited, increase in QTc was observed with citric-acid dialysate (C1.5) and lower calcium acetic-acid dialysate (A1.25).
  • QTc increased from 427 to 444 ms with C1.5 (p=0.007) and from 431 to 449 ms with A1.25 (p<0.001).
  • No significant QTc prolongation was noted with standard acetic-acid dialysate at 1.50 mmol/l calcium (A1.5).

Conclusions:

  • Both citric-acid dialysate (C1.5) and lower calcium acetic-acid dialysate (A1.25) are associated with a significant prolongation of the QTc interval.
  • The observed QTc prolongation was relatively limited, suggesting a potentially manageable risk.
  • Further research is warranted to fully elucidate the clinical implications of these findings in hemodialysis patients.

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