Electrolyte Changes in Contemporary Hemodialysis: A Secondary Analysis of the Monitoring in Dialysis Study
Simon Correa, Katherine M. Scovner, James A. Tumlin, Prabir Roy‐Chaudhury, Bruce A. Koplan, Alexandru Costea, Vijay Kher, Don Williamson, Saurabh Pokhariyal, Candace K. McClure, Finnian R. Mc Causland, David M. Charytan
Abstract
Key Points Electrolyte fluxes after contemporary HD and the relationship between serum electrolytes and dialysate prescription remain understudied. HCO3, Ca, and albumin increased, whereas K, Mg, and PO4 decreased immediately post-HD. Dynamic changes followed at 15- and 30-minutes post-HD. We provide predictive models to estimate the pre- to post-HD change in serum electrolytes. Validation of models is warranted. Background There is a paucity of contemporary data examining electrolyte changes during and immediately after hemodialysis (HD), and their relationship with dialysate prescriptions. This study examines these relationships. Methods We analyzed patient ( n =66) and HD session–level pre and postdialysis laboratory data ( n =1713) over a 6-month period from the Monitoring in Dialysis Study. We fit mixed-effects regression models to analyze electrolyte, BUN, 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 phosphate 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% and 67% of immediate post-HD samples, respectively. Dynamic changes were observed in electrolyte concentrations at 15- and 30-minutes post-HD, compared with immediately post-HD. Conclusions We describe the magnitude of postdialytic 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.