This mentored career development award will provide Dr. Katherine Scovner with the resources,
additional training and protected time necessary to achieve her goal of becoming an independent clinical
investigator. Dr. Scovner has completed her master’s degree in Public Health and will continue to benefit from
her outstanding institutional support and resources through the pursuit of didactic courses for continued formal
education in biostatistics and study design through Harvard Catalyst and the Harvard Master of Medical
Sciences in Clinical Investigation program, research conferences, leadership courses and training in the
responsible conduct of research. These will complement her strong mentoring plan and institutional support
and will build upon her prior training in human investigation.
Approximately 450,000 patients in the United States are treated with life-sustaining hemodialysis (HD)
for end-stage renal disease. These patients experience mortality rates of around 20% per year with nearly a
quarter of their mortality attributed to sudden cardiac death (SCD). This K23 Mentored Career Development
Award proposal (PA-20-206), entitled “Association of Dialysate Bicarbonate with Hemodynamic Instability and
Arrhythmia,” aims to investigate the role that dialysate bicarbonate plays in intradialytic hypotension and in
causing cardiac rhythms which increase the risk for SCD. The goal of this research is to understand how
dialysate bicarbonate interacts with serum pH and electrolytes to impact hemodynamics and cardiac rhythms
and to identify how individualized dialysate prescriptions may reduce hemodynamic instability, arrhythmia and
ultimately SCD in maintenance HD patients.
In Aim 1, we will use data a large dialysis organization to assess how dialysate bicarbonate is
associated with intradialytic hypotension. In Aim 2, data from implanted loop recorders used in the Monitoring
in Dialysis (MiD) study will be analyzed to investigate the associations of serum and dialysate bicarbonate with
clinically significant arrhythmias (defined as sustained ventricular tachycardia, bradycardia, asystole and
symptomatic arrhythmias), QTc prolongation and ventricular ectopy, parameters that are associated with SCD.
Aim 3 proposes a randomized, controlled, double-blind, cross-over trial in 44 maintenance HD outpatients to
measure how dialysate bicarbonate levels affect intradialytic QTc prolongation, ventricular ectopy, clinically
significant arrhythmias and intradialytic hypotension to assess how HD prescriptions might be improved to
prevent cardiac dysrhythmia and hemodynamic instability.
During this award period, Dr. Scovner will employ her unsurpassed academic resources and
mentorship at Brigham and Women’s Hospital to acquire the skills and expertise required to attain R01 and/or
R03 funding, allowing her to continue her critically important research and to train future clinical investigators.