Klinische und experimentelle Kardiologie
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Abstrakt

Cardiovascular Sequelae of Hypokalemia in Hemodialysis Patients

Hazem Mohammad-Ali Farrag, Eman Reda Abdel-Dayem, Abdel-Fttah Mohammad Hussein, Mahmoud Ragab Mohammad and Hasan Mohammad Mohiey- Eddin

Background: Dyskalemia is a serious condition that encountered in End-Stage Renal Disease (ESRD) patients maintained on hemodialysis that may affect their prognosis. We aimed to investigate consequences of dyskalemia in such patients.
Patients and methods: Two-hundred hemodialysis patients underwent laboratory assessment of hemoglobin, blood sugar, renal function, serum albumin, parathormone, ferritin, ionized-calcium and phosphorus. Serum potassium was estimated before and within 2 hour after dialysis. Electrocardiogram (ECG) was obtained just before dialysis session. Transthoracic echocardiography was obtained within 2 hour after dialysis; estimating ventricular systolic and diastolic functions and pulmonary pressure. Twelve-month followed-up was undertaken for mortality.
Results: Patients were divided according to pre-dialysis potassium into hypokalemic (n=26), hyperkalemic (n=56) and normokalemic groups (n=118). Hypokalemic group were older with longer dialysis duration (p<0.001). Dietary potassium varied significantly among groups, with more concomitant medications used in hyperkalemic group (p<0.001). Hypokalemic group showed higher Blood Pressure (BP) (p=0.002), while hyperkalemic group showed lower heart rate (p=0.012). Lower serum albumin and calcium, higher urea, creatinine, phosphorus and
parathormone levels were in hyperkalemic group (p<0.001). Hypokalemic group showed evident ECG changes (p=0.024), increased Left Ventricle (LV) mass (p=0.032) and diastolic dysfunction (P<0.001). Although tendency toward higher mortality in hypo and hyperkalemic groups, no significant difference was observed (p=0.19). Predialysis potassium was negatively correlated with dialysis duration (p<0.001), diastolic BP (p=0.042) and LV mass (p=0.018), and positively correlated with hemoglobin level (p=0.017), serum albumin, phosphorus and parathormone
(p<0.001).
Conclusion: Hypokalemia is as serious as hyperkalemia, being associated with significant cardiovascular consequences in patients on maintenance hemodialysis.