All Title Author
Keywords Abstract

Publish in OALib Journal
ISSN: 2333-9721
APC: Only $99


Impact of Abnormal Serum Electrolyte Levels and Acid-Base Disorders on Clinical Outcomes among Maintenance Hemodialysis Patients

DOI: 10.4236/oalib.1103623, PP. 1-13

Subject Areas: Nephrology, Internal Medicine

Keywords: Chronic Kidney Disease, End-Stage Renal Disease, Hemodialysis, Electrolyte, Acid-Base Disorder

Full-Text   Cite this paper   Add to My Lib


There has been a notable rise in the number of patients diagnosed with chronic kidney disease (CKD) over the years across the world, with most cases subsequently leading to end-stage renal failure. Hemodialysis (HD) remains one of the main treatments for end-stage renal disease (ESRD) worldwide. Despite improvements in dialysis care, the mortality of patients with ESRD on maintenance hemodialysis is persistently high. Abnormal levels of serum electrolytes, pre-and post-dialysis, and acid-base disorders have a crucial influence on clinical outcomes in HD patients. In this review, we aim to discuss the different effects that serum electrolyte levels have on the prognosis of patients on maintenance hemodialysis, particularly sodium, potassium, magnesium, phosphorus and bicarbonate.

Cite this paper

Guttee, V. , Nie, Y. , Wang, Y. and Ding, X. (2017). Impact of Abnormal Serum Electrolyte Levels and Acid-Base Disorders on Clinical Outcomes among Maintenance Hemodialysis Patients. Open Access Library Journal, 4, e3623. doi:


[1]  El Nahas, A.M. and Bello, A.K. (2005) Chronic Kidney Disease: The Global Challenge. The Lancet, 365, 331-340.
[2]  Saran, R., Li, Y., Robinson, B., Ayanian, J., Balkrishnan, R., Bragg-Gresham, J., et al. (2015) US Renal Data System 2014 Annual Data Report: Epidemiology of Kidney Disease in the United States. American Journal of Kidney Diseases, 66, S1-S305.
[3]  Wang, S., Chen, R., Liu, Q., Shu, Z., Zhan, S. and Li, L. (2015) Prevalence, Awareness and Treatment of Chronic Kidney Disease among Middle-Aged and Elderly: The China Health and Retirement Longitudinal Study. Nephrology, 20, 474-484.
[4]  Rhee, C.M., Ravel, V.A., Ayus, J.C., Sim, J.J., Streja, E., Mehrotra, R., et al. (2015) Pre-Dialysis Serum Sodium and Mortality in a National Incident Hemodialysis Cohort. Nephrology Dialysis Transplantation, 1-10.
[5]  Waikar, S.S., Curhan, G.C. and Brunelli, S.M. (2011) Mortality Associated with Low Serum Sodium Concentration in Maintenance Hemodialysis. American Journal of Medicine, 124, 77-84.
[6]  Hecking, M., Karaboyas, A., Saran, R., Sen, A., Horl, W.H., Pisoni, R.L., et al. (2012) Predialysis Serum Sodium Level, Dialysate Sodium, and Mortality in Maintenance Hemodialysis Patients: the Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases, 59, 238-248.
[7]  Kanbay, M., Goldsmith, D., Uyar, M.E., Turgut, F. and Covic, A. (2010) Magnesium in Chronic Kidney Disease: Challenges and Opportunities. Blood Purification, 29, 280-292.
[8]  Yu, L., Li, H. and Wang, S.X. (2017) Serum Magnesium and Mortality in Maintenance Hemodialysis Patients. Blood Purification, 43, 31-36.
[9]  Ohya, M., Negi, S., Sakaguchi, T., Koiwa, F., Ando, R., Komatsu, Y., et al. (2014) Significance of Serum Magnesium as an Independent Correlative Factor on the Parathyroid Hormone Level in Uremic Patients. The Journal of Clinical Endocrinology & Metabolism, 99, 3873-3878.
[10]  Lacson, E., Wang, W., Ma, L. and Passlick-Deetjen, J. (2015) Serum Magnesium and Mortality in Hemodialysis Patients in the United States: A Cohort Study. American Journal of Kidney Diseases, 66, 1056-1066.
[11]  Young, E.W., Akiba, T., Albert, J.M., McCarthy, J.T., Kerr, P.G., Mendelssohn, D.C., et al. (2004) Magnitude and Impact of Abnormal Mineral Metabolism in Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases, 44, 34-38.
[12]  Nakai, S., Akiba, T., Kazama, J., Yokoyama, K., Fukagawa, M., Tominaga, Y., et al. (2008) Effects of Serum Calcium, Phosphorous, and Intact Parathyroid Hormone Levels on Survival in Chronic Hemodialysis Patients in Japan. Therapeutic Apheresis and Dialysis, 12, 49-54.
[13]  Miller, J.E., Kovesdy, CP., Norris, K.C., Mehrotra, R., Nissenson, A.R., Kopple, J.D., et al. (2010) Association of Cumulatively Low or High Serum Calcium Levels with Mortality in Long-Term Hemodialysis Patients. American Journal of Nephrology, 32, 403-413.
[14]  Rivara, M.B., Ravel, V., Kalantar-Zadeh, K., Streja, E., Lau, W.L., Nissenson, A.R., et al. (2015) Uncorrected and Albumin-Corrected Calcium, Phosphorus, and Mortality in Patients Undergoing Maintenance Dialysis. Journal of the American Society of Nephrology, 26, 1671-1681.
[15]  Bommer, J., Locatelli, F., Satayathum, S., Keen, M.L., Goodkin, D.A., Saito, A., et al. (2004) Association of Predialysis Serum Bicarbonate Levels with Risk of Mortality and Hospitalization in the Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases, 44, 661-671.
[16]  Kovesdy, C.P., Regidor, D.L., Mehrotra, R., et al. (2007) Serum and Dialysate Potassium Concentrations and Survival in Hemodialysis Patients. Clinical Journal of the American Society of Nephrology, 2, 999-1007.
[17]  Sakaguchi, Y., Fujii, N., Shoji, T., Hayashi, T., Rakugi, H., Iseki, K., et al. (2014) Magnesium Modifies the Cardiovascular Mortality Risk Associated with Hyperphosphatemia in Patients Undergoing Hemodialysis: A Cohort Study. PLoS ONE, 9, e116273.
[18]  Wu, D.Y., Shinaberger, C.S., Regidor, D.L., McAllister, C.J., Kopple, J.D. and Kalantar-Zadeh, K. (2006) Association between Serum Bicarbonate and Death in Hemodialysis Patients: Is It Better to be Acidotic or Alkalotic? Clinical Journal of the American Society of Nephrology, 1, 70-78.
[19]  Santos Sergio, F.F. and Peixoto, A.J. (2010) Sodium Balance in Maintenance Hemodialysis. Seminars in Dialysis, 23, 549-555.
[20]  Mandai, S., Kuwahara, M., Kasagi, Y., Kusaka, K., Tanaka, T., Shikuma, S., Akita, W. and Sasaki, S. (2013) Lower Serum Sodium Level Predicts Higher Risk of Infection-Related Hospitalization in Maintenance Hemodialysis Patients: An Observational Cohort Study. BMC Nephrology, 14, 276.
[21]  McCausland, F.R., Brunelli, S.M. and Waikar, S.S. (2012) Dialysate Sodium, Serum Sodium and Mortality in Maintenance Hemodialysis. Nephrology Dialysis Transplantation, 27, 1613-1618.
[22]  Nigwekar, S.U., Wenger, J., Thadhani, R. and Bhan, I. (2013) Hyponatremia, Mineral Metabolism, and Mortality in Incident Maintenance Hemodialysis Patients: A Cohort Study. American Journal of Kidney Diseases, 62, 755-762.
[23]  Meira, et al. (2007) Influence of Sodium Profile in Preventing Complications during Hemodialysis. Hemodialysis International, 11, S29-S32.
[24]  Rodrigues Telini, L.S., de Carvalho Beduschi, G., Caramori, J.C., Castro, J.H., Martin, L.C. and Barretti, P. (2014) Effect of Dietary Sodium Restriction on Body Water, Blood Pressure, and Inflammation in Hemodialysis Patients: A Prospective Randomized Controlled Study. International Urology and Nephrology, 46, 91-97.
[25]  Poulikakos, D., Banerjee, D. and Malik, M. (2014) Risk of Sudden Cardiac Death in Chronic Kidney Disease. Journal of Cardiovascular Electrophysiology, 25, 222-231.
[26]  Jadoul, M., Thumma, J., Fuller, D.S., Tentori, F., Li, Y., Morgenstern, H., et al. (2012) Modifiable Practices Associated with Sudden Death among Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study. Clinical Journal of the American Society of Nephrology, 7, 765-774.
[27]  Pun, P.H., Lehrich, R.W., Honeycutt, E.F., Herzog, C.A. and Middleton, J.P. (2011) Modifiable Risk Factors Associated with Sudden Cardiac Arrest within Hemodialysis Clinics. Kidney International, 79, 218-227.
[28]  Nie, Y., Zou, J., Liang, Y., Shen, B., Liu, Z., Cao, X., et al. (2016) Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis. PLoS ONE, 11, e0155445.
[29]  Genovesi, S., Valsecchi, M.G., Rossi, E., Pogliani, D., Acquistapace, I., De Cristofaro, V., et al. (2009) Sudden Death and Associated Factors in a Historical Cohort of Chronic Haemodialysis Patients. Nephrology Dialysis Transplantation, 24, 2529- 2536.
[30]  Hwang, J.C., Jiang, M.Y. and Wang, C.T. (2013) Lower Serum Potassium Combined with Lower Sodium Concentrations Predict Long-Term Mortality Risk in Hemodialysis Patients. BMC Nephrology, 14, 269.
[31]  Yetkin, E., Ileri, M., Tandogan, I., et al. (2000) Increased QT Interval Dispersion after Hemodialysis: Role of Peridialytic Electrolyte Gradients. Angiology, 51, 499- 504.
[32]  Burton, J.O., Grundy, B.J. and McIntyre, C.W. (2008) Hemodialysis-Induced Left Ventricular Dysfunction Is Associated with an Increase in Ventricular Arrhythmias. Renal Failure, 30, 701-709.
[33]  Saravanan, P. and Davidson, N.C. (2010) Risk Assessment for Sudden Cardiac Death in Dialysis Patients. Circulation: Arrhythmia and Electrophysiology, 3, 553- 559.
[34]  Pun, P.H. (2014) The Interplay between CKD, Sudden Cardiac Death, and Ventricular Arrhythmias. Advances in Chronic Kidney Disease, 21, 480-488.
[35]  Morris, S.T., Stewart, G.A., Rodger, R.S. and Jardine, A.G. (1999) QT Dispersion before and after Hemodialysis. Journal of the American Society of Nephrology, 10, 160-163.
[36]  Elsharkawy Magdy, M., Youssef, A.M. and Zayoon, M.Y. (2006) Intradialytic Changes of Serum Magnesium and Their Relation to Hypotensive Episodes in Hemodialysis Patients on Different Dialysates. Hemodialysis International, 10, S16- S23.
[37]  Ishimura, E., Okuno, S., Yamakawa, T., Inaba, M. and Nishizawa, Y. (2007) Serum Magnesium Concentration Is a Significant Predictor of Mortality in Maintenance Hemodialysis Patients. Magnesium Research, 20, 237-244.
[38]  Joao Matias, P., Azevedo, A., Laranjinha, I., Navarro, D., Mendes, M., Ferreira, C., et al. (2014) Lower Serum Magnesium Is Associated with Cardiovascular Risk Factors and Mortality in Haemodialysis Patients. Blood Purification, 38, 244-252.
[39]  De Roij van Zuijdewijn, C.L., Grooteman, M.P., Bots, M.L., Blankestijn, P.J., Steppan, S., Buchel, J., et al. (2015) Serum Magnesium and Sudden Death in European Hemodialysis Patients. PLoS ONE, 10, e0143104.
[40]  Kurita, N., Akizawa, T., Fukagawa, M., Onishi, Y., Kurokawa, K. and Fukuhara, S. (2015) Contribution of Dysregulated Serum Magnesium to Mortality in Hemodialysis Patients with Secondary Hyperparathyroidism: A 3-Year Cohort Study. Clinical Kidney Journal, 8, 744-752.
[41]  Pakfetrat, M., Roozbeh Shahroodi, J., Malekmakan, L., Zare, N., Hashemi Nasab, M. and Hossein Nikoo, M. (2010) Is There an Association between Intradialytic Hypotension and Serum Magnesium Changes? Hemodialysis International, 14, 492-497.
[42]  Liu, F., Zhang, X., Qi, H., Wang, J., Wang, M., Zhang, Y., Yan, H. and Zhuang, S. (2013) Correlation of Serum Magnesium with Cardiovascular Risk Factors in Maintenance Hemodialysis Patients—A Cross-Sectional Study. Magnesium Research, 26, 100-108.
[43]  Tzanakis, I.P.A., Kounali, D., et al. (1997) Mitral Annular Calcifications in Haemodialysis Patients: A Possible Protective Role of Magnesium. Nephrology Dialysis Transplantation, 12, 2036-2037.
[44]  Meema, H.E., Oreopoulous, D.G. and Rapoport, A. (1987) Serum Magnesium Level and Arterial Calcification in End-Stage Renal Disease. Kidney International, 32, 388-394.
[45]  Dousdampanis, P., Trigka, K. and Fourtounas, C. (2014) Hypomagnesemia, Chronic Kidney Disease and Cardiovascular Mortality: Pronounced Association But Unproven Causation. Hemodialysis International, 18, 730-739.
[46]  Nasri, H. and Baradavan, A. (2004) Correlation of Serum Magnesium with Dyslipidemia in Maintenance Hemodialysis Patients. Acta Medica (Hradec Kralove), 47, 263-265.
[47]  Robles, N.R., Escola, J.M., Albarran, L. and Espada, R. (1998) Correlation of Serum Magnesium and Serum Lipid Levels in Hemodialysis Patients. Nephron, 78, 118- 119.
[48]  Ansari, M.R., Maheshwari, N., Shaikh, M.A., Laghari, M.S., Darshana, L.K. and Ahmed, K. (2012) Correlation of Serum Magnesium with Dyslipidemia in Patients on Maintenance Hemodialysis. Saudi Journal of Kidney Diseases and Transplantation, 23, 21-25.
[49]  Khatami, M.R., Mirchi, E., Khazaeipour, Z., Abdollahi, A. and Jahanmardi, A. (2013) Association between Serum Magnesium and Risk Factors of Cardiovascular Disease in Hemodialysis Patients. Iranian Journal of Kidney Diseases, 7, 47-52.
[50]  Pakfetrat, M., Malekmakan, L., Roozbeh, J. and Haghpanah, S. (2008) Magnesium and Its Relationship to C-Reactive Protein among Hemodialysis Patients. Magnesium Research, 21, 167-170.
[51]  Atsumi, K., Kushida, K., Yamazaki, K., Shimizu, S., Ohmura, A. and Inoue, T. (1999) Risk Factors for Vertebral Fractures in Renal Osteodystrophy. American Journal of Kidney Diseases, 33, 287-293.
[52]  Marchais, S.J., Metivier, F., Guerin, A.P. and London, G.M. (1999) Association of Hyperphosphataemia with Haemodynamic Disturbances in End-Stage Renal Disease. Nephrology Dialysis Transplantation, 14, 2178-2183.
[53]  Rodriguez-Benot, A., Martin-Malo, A., Alvarez-Lara, M.A., Rodriguez, M. and Aljama, P. (2005) Mild Hyperphosphatemia and Mortality in Hemodialysis Patients. American Journal of Kidney Diseases, 46, 68-77.
[54]  Lindsay, R.M., Alhejaili, F., Nesrallah, G., Leitch, R., Clement, L., Heidenheim, A.P. and Kortas, C. (2003) Calcium and Phosphate Balance with Quotidian Hemodialysis. American Journal of Kidney Diseases, 42, 24-29.
[55]  Waheed, A.A., Pedraza, F., Lenz, O. and Isakova, T. (2013) Phosphate Control in End-Stage Renal Disease: Barriers and Opportunities. Nephrology Dialysis Transplantation, 28, 2961-2968.
[56]  Huang, C.X., Plantinga, L.C., Fink, N.E., Melamed, M.L., Coresh, J. and Powe, N.R. (2008) Phosphate Levels and Blood Pressure in Incident Hemodialysis Patients: A Longitudinal Study. Advances in Chronic Kidney Disease, 15, 321-331.
[57]  Blayney, M.J. and Tentori, F. (2009) Trends and Consequences of Mineral Bone Disorder in Haemodialysis Patients: Lessons from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Journal of Renal Care, 35, 7-13.
[58]  Schwarz, U. (2000) Morphology of Coronary Atherosclerotic Lesions in Patients with End-Stage Renal Failure. Nephrology Dialysis Transplantation, 15, 218-233.
[59]  Lertdumrongluk, P., Rhee, C.M., Park, J., Lau, W.L., Moradi, H., Jing, J., et al. (2013) Association of Serum Phosphorus Concentration with Mortality in Elderly and Nonelderly Hemodialysis Patients. Journal of Renal Nutrition, 23, 411-421.
[60]  Rubel, J.R. and Milford, E.L. (2003) The Relationship between Serum Calcium and Phosphate Levels and Cardiac Valvular Procedures in the Hemodialysis Population. American Journal of Kidney Diseases, 41, 411-421.
[61]  Zuchelli, P. and Santaro, A. (1993) Correction of Acid-Base Balance by Dialysis. Kidney International, 43, 179-183.
[62]  National Kidney Foundation (2001) K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure. American Journal of Kidney Diseases, 36, S1-S140.
[63]  National Kidney Foundation (2003) K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. American Journal of Kidney Diseases, 42, S1-S201.
[64]  Fouque, D., Vennegoor, M., ter Wee, P., Wanner, C., Basci, A., et al. (2007) EBPG Guideline on Nutrition. Nephrology Dialysis Transplantation, 22, ii45-ii87.
[65]  Voss, D., Hodson, E. and Crompton, C. (2007) Nutrition and Growth in Kidney Disease: CARI Guidelines. Australian Family Physician, 36, 253-254.
[66]  Lowrie, E.G. and Lew, N. (1990) Death Risk in Hemodialysis Patients: The Predictive Value of Commonly Measured Variables and an Evaluation of Death Rate Differences between Facilities. American Journal of Kidney Diseases, 15, 458-482.
[67]  Yamamoto, T., Shoji, S., Yamakawa, T., Wada, A., Suzuki, K., Iseki, K., et al. (2015) Predialysis and Postdialysis pH and Bicarbonate and Risk of All-Cause and Cardiovascular Mortality in Long-term Hemodialysis Patients. American Journal of Kidney Diseases, 66, 469-478.


comments powered by Disqus

Contact Us


微信:OALib Journal