They prospectively looked at 476 patients in 5 Italian hemodialysis units. The cohort was tracked for 3 years and had 167 deaths (35%), 32 due to SCD and 35 due to other CVD. On multivariate analysis they found the following risk factors for SCD:
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0ax5n-gVjGHJ-NzZchRkeGG3uqynsdlaPEYoskNyqNx18ZqJuXPxCLK42JRotXSgVFb3KQeJOjB0BVBAvDN5JP8f2tk9BAle7YtCXzWLxiOXrsGittCfnxyRMx7kMrzGdFZEKscaZdS0/s400/Picture+3.png)
The most interesting analysis was when they parsed out the day of the week the patients died of SCD. Instead of looking at the absolute day they related the day to the patients dialysis schedule. I have modifed their chart to reflect this, with twin X-axis: one for MWF and another for TTS patients.
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3qd4kjmndOS55VMxM-33CtjsLN4YH10cHFbA4gOQnxfMpacH8HfEAfv9aMYUSYLBF5x8xtk3CEfTPO0j-3Lu7EYDMIxJuL5_0xYH5cWBSLKwAPk4h9q4yAKL7fC6AI4f5v9i-CaiFwWU/s400/Picture+2.png)
This sounds like an electrolyte associated complication rather than a uremic toxin because of the risk after dialysis, indicating the change in the toxin, not just the high level, is a risk-factor. This is supported by studies (1, 2) of potassium modeling in which the potassium in the dialysate is lowered sequentially during dialysis. By modeling the potassium, the speed of potassium removal is decreased. This has been shown to decrease pre-mature ventricular contractions (a benign momentary disturbance in the heart rhythm that is being used as a proxy for more serious arhythmias, like SCD. Medicine has gotten in trouble with this proxy in the past so it may not be appropriate.).
Summary: modestly high potassiums are associated increased SCD and the two day dialysis holiday on traditional three day a week dialysis is likewise associated with SCD. Hello daily dialysis!
The lecture on Potassium that this entry was drawn from:
Whats New In Potassium
View more presentations from Joel Topf.