The Case of Bradycardia Occured in the Setting of Hyperkalemia in a Patient in Ambulatory Hemodialysis Department

The presented article contains the clinical observation of bradycardia development in 64-year-old patient with chronic kidney disease who was in ambulatory treatment at the hemodialysis department. During electrocardiogram recording an arrhythmia was detected as a junctional rhythm. The specific changes on electrocardiogram, presence of risk factors, and data of additional collection of history disease allowed purposing the development of dangerous condition — hyperkalemia. The diagnosis was confirmed after detection of the serum potassium level. This case illustrates the necessity to consider the possibility of hyperkalemia in patients with chronic kidney diseases including those who undergoing hemodialysis treatment. Relevant clinical manifestations and changes on the electrocardiogram require the urgent assessment of the serum potassium level for timely and adequate correction of the electrolyte disorder.

bradycardia, junctional rhythm, cardiac arrhythmias, hyperkalemia, potassium, risk factors, chronic kidney disease, hemodialysis

1. Dhondup T, Qian Q. Electrolyte and acid-base disorders in chronic kidney disease and end-stage kidney failure. Blood Purif. 2017; 43(1-3): 179-188. doi: 10.1159/000452725.

2. Soar J, Perkins GD, Abbas G, et al. European resuscitation council guidelines for resuscitation 2010 Section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010 Oct; 81(10): 1400-1433. doi: 10.1016/j.resuscitation.2010.08.015.

3. Littmann L, Gibbs MA. Electrocardiographic manifestations of severe hyperkalemia. J Electrocardiol. Sep-Oct 2018; 51(5): 814-817. doi: 10.1016/j.jelectrocard.2018.06.018.

4. Palaka E, Grandy S, Darlington O, et al. Associations between serum potassium and adverse clinical outcomes: a systematic literature review. Int J Clin Pract. 2020 Jan; 74(1): e13421. doi: 10.1111/ijcp.13421.

5. Montford JR, Linas S. How dangerous is hyperkalemia? J Am Soc Nephrol. 2017 Nov; 28(11): 3155-3165. doi: 10.1681/ASN.2016121344.

6. Dyadyk A.I., Taradin G.G., Suliman Yu.V. i dr. Diuretics in chronic kidney disease. The Russian Archives of Internal Medicine. 2020; 10(1): 10-20. DOI: 10.20514/2226-6704-2020-10-1-10-20 [In Russian].

7. Rodan AR. Potassium: friend or foe? Pediatr Nephrol. 2017 Jul; 32(7): 1109-1121. doi: 10.1007/s00467-016-3411-8.

8. Durfey N, Lehnhof B, Bergeson A, et al. Severe hyperkalemia: can the electrocardiogram risk stratify for short-term adverse events? West J Emerg Med. 2017 Aug; 18(5): 963-971. doi: 10.5811/westjem.2017.6.33033

9. Goldberger’s clinical electrocardiography: a simplified approach / Ary L. Goldberger, Zachary D. Goldberger, Alexei Shvilkin.− 8th ed. 2013. — p. 92-100.

10. Vatutin N.T., Shevelek A.N., Karapysh V.A. et al. Atrioventricular block: the past and the present. Aritmologiya = Arrhythmology. 2014;10(2);26-35. [In Russian].

11. Montague BT, Ouellette JR, Buller GK. Retrospective review of the frequency of ECG changes in hyperkalemia. Clin J Am Soc Nephrol. 2008 Mar; 3(2): 324-330. doi: 10.2215/CJN.04611007.

12. Rhee CM. Serum potassium and the long interdialytic interval: minding the Gap. Am J Kidney Dis. 2017 Jul; 70(1): 4-7. doi: 10.1053/j.ajkd.2017.04.007.

13. Orlov V.N. Manual of electrocardiography. — 9-th. ed. — M: «Meditsinskoe informatsionnoe agentstvo» Ltd. 2017; p. 535-543. [In Russian].

14. Korgaonkar S, Tilea A, Gillespie BW, et al. Serum potassium and outcomes in CKD: insights from the RRI-CKD cohort study. Clin J Am Soc Nephrol. 2010 May; 5(5): 762-769. doi: 10.2215/CJN.05850809.

15. Hunter RW, Bailey MA. Hyperkalemia: pathophysiology, risk factors and consequences. Nephrol Dial Transplant. 2019 Dec 1; 34(Suppl 3): iii2-iii11. doi: 10.1093/ndt/gfz206.

16. Seliger SL. Hyperkalemia in patients with chronic renal failure. Nephrol Dial Transplant. 2019 Dec 1; 34(Suppl 3): iii12-iii18. doi: 10.1093/ndt/gfz231.

17. Dépret F, Peacock WF, Liu KD, et al. Management of hyperkalemia in the acutely ill patient. Ann Intensive Care. 2019 Feb 28; 9(1): 32. doi: 10.1186/s13613-019-0509-8.

18. Clase CM, Carrero JJ, Ellison DH, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020 Jan; 97(1): 42-61. doi: 10.1016/j.kint.2019.09.018.