A case series of chronic haemodialysis patients: mortality, sudden death, and QT interval

Genovesi, Simonetta; Rossi, Emanuela; Nava, M D Andrea; Riva, Hilary; Franceschi, Silvia De; Fabbrini, Paolo; Viganò, M; Pieruzzi, Federico; Stella, Andréa; Valsecchi, Maria Grazia; Stramba-Badiale, Marco

doi:10.1093/europace/eus412

Cited by 52 publications

(48 citation statements)

References 26 publications

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“…In another study, no difference in the blood pressure response between high and low DCa was van found [19]. Cardiac arrhythmias are more common in patients being treated with a DCa below 2.5 mEq/L and they also increase the risk of sudden cardiac death [20,21], which may be possibly related to a prolongation of the QT interval with low DCa levels [21,22]. Interestingly, in a recent study, the authors demonstrated that a DCa of 3.5 mEq/L compared with 2.5 mEq/L was associated with an increase in the heart rate variability LF/HF ratio, denoting higher sympathetic activity when compared to low DCa [23].…”

Section: Short-and Long-term Effects Of Dca On Clinical Outcomesmentioning

confidence: 99%

Dialysate Calcium Levels: Do They Matter?

et al. 2018

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Background: Calcium (Ca) is an essential element that plays a critical role in many biological processes. In dialysis patients, the regulation of Ca balance is highly complex, given the absence of kidney function, endocrine disturbances and the use of drugs such as phosphate binders, vitamin D analogues, and calcimimetics. Also, the use of different dialysate Ca (DCa) baths has profound effect on Ca balance, which depends both on the difference between the Ca concentration in the bath and the serum of the patients, as on the ultrafiltration volume. Summary: The choice of DCa may have important short- and long-term consequences. While lower DCa (especially < 2.5 mEq/L) concentrations have been associated with an increased risk of sudden cardiac death in observational studies, DCa in the higher ranges (3.0 mEq/L and above) may contribute to vascular pathology. Intra-dialytic hemodynamics may also be affected by the choice of DCa. In general, lower DCa concentrations are associated with an increase, and higher DCa concentrations with a decrease in parathyroid hormone (PTH) levels. Preliminary data has suggested that a DCa of 2.75 mEq/L may help in obtaining a net zero intradialytic Ca balance in individual patients, but clinical experience is still limited. Key Message: The optimal Ca balance depends on multiple parameters including blood Ca levels, PTH and the use of phosphate binders and vitamin D analogues, as well as on the risk of hemodynamic stability and cardiac arrhythmias. Therefore, DCa prescription should be individualised. A DCa of 2.75 mEq/L may be useful adjunct for dialysis providers.

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Section: Short-and Long-term Effects Of Dca On Clinical Outcomesmentioning

confidence: 99%

Dialysate Calcium Levels: Do They Matter?

et al. 2018

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“…Over one third of patients on hemodialysis will have a prolonged QTc interval prior to a dialysis session [11,12]. The dialysis session itself, however, has a heterogeneous effect on QTc interval; some studies have demonstrated that hemodialysis is associated with QTc prolongation [12,13], while others have found no such association [11,14]. These disparate results are likely the result of variations in patient characteristics, coexisting cardiac comorbidities, and dialysis bath electrolyte concentrations among studies [15].…”

Section: Qt Intervalmentioning

confidence: 99%

“…QTc interval was evaluated in 122 patients on chronic hemodialysis (median age 71 years, 65% male, 38% with coronary artery disease (CAD), and median LVEF 60%) [11]. Importantly, 28% of this study population was on amiodarone.…”

Section: Qt Intervalmentioning

confidence: 99%

Electrocardiographic predictors of mortality and sudden cardiac death in patients with end stage renal disease on hemodialysis

Waks

Tereshchenko

Parekh

2016

Journal of Electrocardiology

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Patients with end stage renal disease (ESRD) on hemodialysis experience a high incidence of cardiovascular mortality, and sudden cardiac death (SCD) accounts for approximately 25% of all deaths in this patient population. Despite this high risk of SCD, many non-invasive SCD risk stratification tools that are frequently applied to other patient populations (such as those with prior myocardial infarction and reduced left ventricular systolic function) may be less useful markers of increased SCD risk in ESRD. Improved SCD risk stratification tools for use specifically in patients on hemodialysis are therefore necessary to optimally target use of primary prevention interventions aimed at decreasing SCD incidence. Electrocardiography is an effective, non-invasive SCD risk stratification tool in hemodialysis patients. This article reviews data supporting the association between various ECG parameters (QT interval, spatial QRS-T angle, signal averaged ECG, heart rate variability, and T-wave alternans) and mortality/SCD in the dialysis population. Despite the association between abnormal ECG parameters and SCD, it remains unclear if these abnormal parameters (such as prolonged QT interval) are mechanistically related to SCD and/or ventricular arrhythmias, or if they are simply markers for more severe cardiac disease, such as left ventricular hypertrophy, that may independently predispose to SCD. Current obstacles that impair widespread implementation of ECG risk stratification in the hemodialysis population are also discussed..

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“…Patients on dialysis (stage 5 CKD) with ICD implantation: Patients on dialysis often present with repolarization abnormalities, including a prolonged QT interval, 33) microvolt T wave alterans, 34) and abnormal T wave morphology. 35,36) Moreover, repolarization abnormalities have been associated with SCD and all-cause mortality in patients on dialysis.…”

Section: )mentioning

confidence: 99%

“…35,36) Moreover, repolarization abnormalities have been associated with SCD and all-cause mortality in patients on dialysis. 33) Patients on dialysis have a 10 to 20-fold higher risk of suffering from SCD than patients without CKD. 5) SCD is the most common cause of death in dialysis patients, accounting for 20-35% of allcause mortality in patients on dialysis.…”

Section: )mentioning

confidence: 99%

Do Implantable Cardioverter Defibrillators Reduce Mortality in Patients With Chronic Kidney Disease at All Stages?

Zhou

Zhu

et al. 2017

Int. Heart J.

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SummaryThe benefits of implantable cardioverter defibrillator (ICD) implantation in chronic kidney disease (CKD) patients with high sudden cardiac death (SCD) risk are uncertain. To clarify the effects of receiving an ICD in CKD patients, we conducted this meta-analysis to identify the effects of ICDs on patients with CKD, including those on dialysis. We searched the Cochrane library, EMBASE, PubMed, and clinical trials for studies published before July 2016. Eleven studies including 20,196 CKD patients were considered for inclusion. The pooled analysis suggested that patients with an estimated glomerular filtration rate (eGFR) < 60 mL/minute/1.73 m 2 would benefit from receiving treatments with ICDs compared with patients without an ICD device (aHR = 0.77; 95% confidence interval [CI], 0.63 to 0.95). This is the first report of a subgroup analysis on the survival rate of ICD implantation in CKD patients according to an eGFR group. The subgroup analysis indicated a similar protective association of ICDs in stage 3 CKD patients (aHR = 0.71; 95%CI, 0.61 to 0.82) compared with the control group. However, there was no significant improvement in all-cause mortality in stage 4 CKD patients (aHR = 1.02; 95%CI, 0.75 to 1.37) or stage 5 CKD patients (aHR = 0.80; 95%CI, 0.60 to 1.31). This is the first meta-analysis reporting that ICD implantation reduces all-cause mortality in stage 3 CKD patients. However, the data do not indicate there is any benefit to ICD implantation in stage 4 or 5 CKD patients. (Int Heart J 2017; 58: 371-377)

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A case series of chronic haemodialysis patients: mortality, sudden death, and QT interval

Abstract: In a case series of HD patients, QTc was associated with total mortality and SCD. Further studies to test this hypothesis in a larger population are necessary.

Cited by 52 publications

References 26 publications

Dialysate Calcium Levels: Do They Matter?

Dialysate Calcium Levels: Do They Matter?

Electrocardiographic predictors of mortality and sudden cardiac death in patients with end stage renal disease on hemodialysis

Do Implantable Cardioverter Defibrillators Reduce Mortality in Patients With Chronic Kidney Disease at All Stages?

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