Advertisement

Electrolyte abnormalities and laboratory findings in patients with out-of-hospital cardiac arrest who have kidney disease

Published:November 19, 2012DOI:https://doi.org/10.1016/j.ajem.2012.09.021

      Abstract

      Purposes

      Although electrolyte abnormalities have been generally considered the major cause of out-of-hospital cardiac arrest (OHCA) in patients with kidney disease (KD), this association has never been prospectively validated.

      Methods

      A prospective, observational study was conducted in a tertiary university hospital between January 2008 and December 2009. The study sample consisted of consecutively admitted patients with nontraumatic OHCA. Based on the estimated glomerular filtration rate (eGFR, unit: milliliters per minute per 1.73 m2), the enrollees were divided into 3 groups: group A (normal kidney function or mild KD; eGFR, 60.0), group B (moderate KD; eGFR between 15.0 and 59.9), and group C (severe KD; eGFR<15.0 or on dialysis). The laboratory findings of the groups were compared. Two-tailed P values less than .005 were considered significant.

      Results

      Two hundred thirty-four enrollees (137 were male) were divided into 3 groups: group A (n = 51; 21.8%), group B (n = 128; 54.7%), and group C (n = 55; 23.5%). Compared with the other 2 groups, group C presented significantly higher serum potassium and magnesium and lower pH and hemoglobin level (all P < .005). After stratifications of the significant variables, a post hoc analysis revealed that group C presented significantly higher incidences of hypermagnesemia (Mg >2.5 mmol/L) and severe hyperkalemia (K >6.5 mmol/L) (both P < .005) than the other 2 groups. The odds ratios of the incidence of severe hyperkalemia in group C was 3.37 (95% confidence intervals, 1.46-7.77) compared with group A (50.9% vs 23.5%, P < .005).

      Conclusions

      Severe hyperkalemia is common in patients with OHCA who have severe KD and should be considered during resuscitation for these patients.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Boddana P.
        • Caskey F.
        • Casula A.
        • et al.
        UK Renal Registry 11th Annual Report (December 2008): chapter 14 UK Renal Registry and international comparisons.
        Nephron Clin Pract. 2009; 111: c269-c276
        • Collins A.J.
        • Foley R.N.
        • Chavers B.
        • et al.
        United States Renal Data System 2011 Annual Data Report: atlas of chronic kidney disease & end-stage renal disease in the United States.
        Am J Kidney Dis. 2011; 59: e1-e420
        • Herzog C.A.
        • Mangrum J.M.
        • Passman R.
        Sudden cardiac death and dialysis patients.
        Semin Dial. 2008; 21: 300-307
        • Ritz E.
        • Wanner C.
        The challenge of sudden death in dialysis patients.
        Clin J Am Soc Nephrol. 2008; 3: 920-929
        • Shamseddin M.K.
        • Parfrey P.S.
        Sudden cardiac death in chronic kidney disease: epidemiology and prevention.
        Nat Rev Nephrol. 2011; 7: 145-154
        • Green D.
        • Roberts P.R.
        • New D.I.
        • et al.
        Sudden cardiac death in hemodialysis patients: an in-depth review.
        Am J Kidney Dis. 2011; 57: 921-929
        • Tzamaloukas A.H.
        • Avasthi P.S.
        Temporal profile of serum potassium concentration in nondiabetic and diabetic outpatients on chronic dialysis.
        Am J Nephrol. 1987; 7: 101-109
        • Hsieh M.F.
        • Wu I.W.
        • Lee C.C.
        • et al.
        Higher serum potassium level associated with late stage chronic kidney disease.
        Chang Gung Med J. 2011; 34: 418-425
        • Bowling C.B.
        • Pitt B.
        • Ahmed M.I.
        • et al.
        Hypokalemia and outcomes in patients with chronic heart failure and chronic kidney disease: findings from propensity-matched studies.
        Circ Heart Fail. 2010; 3: 253-260
        • Jain N.
        • Kotla S.
        • Little B.B.
        • et al.
        Predictors of hyperkalemia and death in patients with cardiac and renal disease.
        Am J Cardiol. 2012; 109: 1510-1513
        • Desai A.S.
        • Swedberg K.
        • McMurray J.J.
        • et al.
        Incidence and predictors of hyperkalemia in patients with heart failure: an analysis of the CHARM program.
        J Am Coll Cardiol. 2007; 50: 1959-1966
        • Mattu A.
        • Brady W.J.
        • Robinson D.A.
        Electrocardiographic manifestations of hyperkalemia.
        Am J Emerg Med. 2000; 18: 721-729
        • Neumar R.W.
        • Otto C.W.
        • Link M.S.
        • et al.
        Part 8: adult advanced cardiovascular life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2010; 122: S729-S767
        • Jacobs I.
        Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: update and simplification of the utstein templates for resuscitation registries: a statement for healthcare professionals from a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa).
        Circulation. 2004; 110: 3385-3397
        • Smith H.W.
        Comparative physiology of the kidney.
        J Am Med Assoc. 1953; 153: 1512-1514
        • National Kidney Foundation
        K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.
        Am J Kidney Dis. 2002; 39: S1-S266
        • Lindeman R.D.
        • Tobin J.
        • Shock N.W.
        Longitudinal studies on the rate of decline in renal function with age.
        J Am Geriatr Soc. 1985; 33: 278-285
        • Levey A.S.
        • Coresh J.
        • Balk E.
        • et al.
        National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification.
        Ann Intern Med. 2003; 139: 137-147
        • Pun P.H.
        • Smarz T.R.
        • Honeycutt E.F.
        • et al.
        Chronic kidney disease is associated with increased risk of sudden cardiac death among patients with coronary artery disease.
        Kidney Int. 2009; 76: 652-658
        • Levey A.S.
        • Coresh J.
        • Greene T.
        • et al.
        Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values.
        Clin Chem. 2007; 53: 766-772
        • Vanden Hoek T.L.
        • Morrison L.J.
        • Shuster M.
        • et al.
        Part 12: cardiac arrest in special situations: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2010; 122: S829-S861
        • Volkova N.
        • Arab L.
        Evidence-based systematic literature review of hemoglobin/hematocrit and all-cause mortality in dialysis patients.
        Am J Kidney Dis. 2006; 47: 24-36
        • Weiner I.D.
        • Wingo C.S.
        Hyperkalemia: a potential silent killer.
        J Am Soc Nephrol. 1998; 9: 1535-1543
        • Lehnhardt A.
        • Kemper M.J.
        Pathogenesis, diagnosis and management of hyperkalemia.
        Pediatr Nephrol. 2011; 26: 377-384
        • Kraut J.A.
        • Kurtz I.
        Metabolic acidosis of CKD: diagnosis, clinical characteristics, and treatment.
        Am J Kidney Dis. 2005; 45: 978-993
        • Kao K.C.
        • Huang C.C.
        • Tsai Y.H.
        • et al.
        Hyperkalemic cardiac arrest successfully reversed by hemodialysis during cardiopulmonary resuscitation: case report.
        Chang Gung Med J. 2000; 23: 555-559
        • Vukmir R.B.
        • Katz L.
        Sodium bicarbonate improves outcome in prolonged prehospital cardiac arrest.
        Am J Emerg Med. 2006; 24: 156-161
        • Morrison G.
        • Michelson E.L.
        • Brown S.
        • et al.
        Mechanism and prevention of cardiac arrhythmias in chronic hemodialysis patients.
        Kidney Int. 1980; 17: 811-819
        • Jadoul M.
        • Thumma J.
        • Fuller D.S.
        • et al.
        Modifiable practices associated with sudden death among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study.
        Clin J Am Soc Nephrol. 2012; 7: 765-774
        • Spiegel D.M.
        Magnesium in chronic kidney disease: unanswered questions.
        Blood Purif. 2011; 31: 172-176
        • Kazory A.
        • Ross E.A.
        Anemia: the point of convergence or divergence for kidney disease and heart failure?.
        J Am Coll Cardiol. 2009; 53: 639-647
        • Davis T.R.
        • Young B.A.
        • Eisenberg M.S.
        • et al.
        Outcome of cardiac arrests attended by emergency medical services staff at community outpatient dialysis centers.
        Kidney Int. 2008; 73: 933-939
        • Ma M.H.
        • Chiang W.C.
        • Ko P.C.
        • et al.
        Outcomes from out-of-hospital cardiac arrest in Metropolitan Taipei: does an advanced life support service make a difference?.
        Resuscitation. 2007; 74: 461-469
        • Ahn K.O.
        • Shin S.D.
        • Suh G.J.
        • et al.
        Epidemiology and outcomes from non-traumatic out-of-hospital cardiac arrest in Korea: a nationwide observational study.
        Resuscitation. 2010; 81: 974-981
        • Owens H.
        • Siparsky G.
        • Bajaj L.
        • et al.
        Correction of factitious hyperkalemia in hemolyzed specimens.
        Am J Emerg Med. 2005; 23: 872-875