Krahn RE, et al. - In 47 patients with end-stage renal disease (ESRD) on chronic hemodialysis (HD), researchers determined how frequency of ventricular arrhythmia was influenced by metabolic alkalosis induced by HD with an acetate-containing bicarbonate-buffered dialysate. They used 48-h Holter monitoring in 3 phases: intra-HD, post-HD day 1, and post-HD day 2. At pre-HD, post-HD, 20-h post-HD, and 44-h post-HD, they measured serum levels of bicarbonate, calcium, and potassium along with hemodynamics. They performed correlations to investigate direct or indirect associations of the HD-induced change in serum bicarbonate level (metabolic alkalosis) with ambient ventricular arrhythmia (premature ventricular contractions per hour). Findings revealed an association of high-bicarbonate dialysate prescription with metabolic alkalosis following the HD procedure. No direct association of a mild metabolic alkalosis induced by HD with an acetate-containing bicarbonate-buffered dialysate solution, with ambient ventricular arrhythmia on Holter monitoring was observed, and nor this was found to be related to changes in hemodynamics or changes in serum total calcium or potassium levels. Findings offer guidance for the safe use of high bicarbonate dialysate/prescription in patients with ESRD on HD.