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Nephrol Dial Transplant (2001) 16: 1090
© 2001 European Renal Association-European Dialysis and Transplant Association

Letters

Serum potassium levels and atrial fibrillation in haemodialysis patients

Asher Korzets, Yaacov Ori and Michal Herman

Department of Nephrology, Rabin Medical Center, Campus Golda, Petach Tikva, Israel

Sir,

We read, with interest, the article in the June edition of NDT regarding atrial fibrillation in dialysis patients [1].

We do feel, however, that a potentially important point was missing. Haemodialysis patients drop their serum potassium levels during a haemodialysis treatment session. When dialysed ‘against’ a potassium concentration of 2 mEq/l, these patients will become relatively hypokalaemic during the last 2 h of a standard 4-h treatment. During this period atrial fibrillation commonly occurs. Also, Zebe rightly points out that ‘atrial fibrillation ... as a rule stops spontaneously without therapeutic intervention 2–3 h after the dialysis session’. Could this return to sinus rhythm be attributable, at least in part, to the sharp rise in serum potassium levels known to occur after dialysis has ended?

Hypokalaemia is considered to be an accepted risk factor for both ventricular and supraventricular arrhythmias [2]. This has been shown in patients on prolonged diuretic therapy [3], and hypokalaemia may actually be a serious problem in patients with either an acute myocardial infarction [4], or with a failing heart [5].

For this reason most of our dialysis patients who have a previous history of atrial fibrillation occurring during haemodialysis are subsequently dialysed ‘against’ a dialysis potassium concentration of 3.0 mEq/l. This is irrespective if the patient is receiving digoxin or not.

Finally, it may be interesting to speculate whether intradialytic magnesium supplementation may help in ameliorating atrial fibrillation in these patients [6].

References

  1. Zebe H. Atrial fibrillation in dialysis patients. Nephrol Dial Transplant2000; 15: 765–768[Free Full Text]
  2. Wahr JA, Parks R, Boisvert D. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. Multicenter Study of Perioperative Ischemia Research Group. JAMA1999; 281: 2203–2210[Abstract/Free Full Text]
  3. Emara MK, Saadet AM. Transient atrial fibrillation in hypertensive patients with thiazide induced hypokalemia. Postgrad Med J1986; 62: 1125–1127[Abstract/Free Full Text]
  4. Nordrehaug JE. Malignant arrhythemia in relation to serum potassium in acute myocardial infarction. Am J Cardiol1985; 56: 20D–23D[Medline]
  5. Oakley C. Genesis of arrhythemias in the failing heart and therapeutic implications. Am J Cardiol1991; 67: 26C–28C[Medline]
  6. Nurozler F, Tokogozoglu L, Passaglu I. Atrial fibrillation after coronary artery bypass surgery: predictors and the role of magnesium sulphate replacement. J Card Surg1996; 11: 421–427[Web of Science][Medline]

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This Article
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