[Prevention of cardiac arrhythmias in hemodialysis: what are the modulating factors?].

La mort subite est la premiere cause de mortalite chez les patients souffrant d'une insuffisance renale terminale traites par dialyse chronique. La technique de dialyse utilisee et la composition chimique du dialysat influencent l'incidence des arythmies. Des etudes pilotes demontrent que l'utilisation d'un dialysat sans acetate avec perfusion de bicarbonate de sodium en aval du filtre de dialyse, couplee a une modulation du profil de potassium pendant la seance de dialyse, ou acetate free biofiltration with potassium profiled dialysate, permet de reduire l'incidence des arythmies, l'intervalle QT et sa dispersion. La limitation du volume de soustraction liquidienne pendant la dialyse et l'augmentation de la concentration de calcium dans le dialysat constituent d'autres strategies anti-arythmogenes possibles Sudden death is the first cause of mortality in patients with end stage renal disease undergoing chronic dialysis treatment. The technique of dialysis as well as the chemical composition of the dialysate can impact on the incidence of cardiac arrhythmias. Pilot studies reveal that the use of an acetate-free dialysate with a downstream filter infusion of sodium bicarbonate, coupled with a modulated potassium-profiled dialysate during hemodialysis, or acetate free biofiltration with potassium profiled dialysate, reduces the incidence of arrhythmias, the QT interval and QT dispersion. The limitation of the ultrafiltration volume during the dialysis session, and the increase in calcium concentration in the dialysate are other possible strategies to reduce cardiac arrhythmias.