Cell-associated magnesium and QT dispersion in hemodialysis patients

Averbukh, Zhan; Rosenberg, R; Galperin, Elena; Berman, Sylvia; Cohn, M.; Cohen, Neale; Modai, David; Efrati, Shai; Weissgarten, Joshua

doi:10.1053/ajkd.2003.50004

Cited by 17 publications

(29 citation statements)

References 36 publications

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“…In a previous study we have demonstrated that in PBMC from patients on chronic HD, total intracellular Mg levels are significantly increased, directly correlating with deleterious prolongation of QTd [8]. Our present results not only confirm previous observations, but also demonstrate that targeting RAS by ACE inhibition or by AT-1 receptor blockade decreased total intracellular Mg in PBMC from HD patients.…”

Section: Discussionsupporting

confidence: 91%

“…It is alarmingly prolonged in HD patients and is increased even further at the end of each dialysis session [5, 8]. To the best of our knowledge, the results presented here demonstrate, for the first time, that evidential QTd reduction can be successfully achieved in HD patients when targeting RAS by means of either ACEi or ARB therapy.…”

Section: Discussionmentioning

confidence: 82%

“…The latter is especially true for patients on HD therapy [5]. In this patient population, QTd was not only found to be significantly prolonged compared to healthy subjects, but proven to increase further in a given individual at the end of the HD session [5, 8]. The underlying mechanisms remain unclear.…”

Section: Introductionmentioning

confidence: 99%

“…The underlying mechanisms remain unclear. Recently, however, an elevation of intracellular magnesium (Mg) has been implicated in sudden cardiac deaths frequently occurring in HD patients in the immediate post-dialysis period [4], while in a different study prolongation of QTd was found to correlate with increased total intracellular Mg levels in HD patients with excessive daily Mg intake [8]. Moreover, in these patients, both intracellular Mg and QTd were further elevated at the end of the HD session [8].…”

Section: Introductionmentioning

confidence: 99%

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Blockade of Renin-Angiotensin System Reduces QT Dispersion and Improves Intracellular Ca/Mg Status in Hemodialysis Patients

Averbukh¹,

Berman²,

Efrati³

et al. 2006

Nephron Clin Pract

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Background: Electrolyte impairments are common in hemodialysis (HD) patients. Consequently, QT dispersion (QTd) is prolonged, correlating with high intracellular magnesium. In patients with cardiac disorders, renin-angiotensin system (RAS) inhibition reduces QTd. Aim: To compare the effects of ACE inhibition or AT-1 blockade on QTd duration and intracellular magnesium (Mg)/calcium (Ca) in peripheral blood mononuclear cells (PBMC) from chronic HD patients. Methods: 24 HD patients received cilazapril for 8 weeks and, following a 2-week withdrawal, were switched to valsartan for additional 8 weeks. QTd measurements and PBMC isolation were performed at the beginning and the end of each period. Total intracellular Ca and Mg were assessed by atomic spectrometer, and cytosolic free Ca²⁺ by fluorocytometer. Results: Both treatments significantly decreased QTd, demonstrating similar reduction magnitudes. In both groups, PBMC exhibited basally low cytosolic Ca²⁺ and undisturbed high transmembrane Ca²⁺ influx following phytohemagglutinin stimulation. Total intracellular Ca was increased, while Mg was reduced, following either treatment. The total intracellular Ca/Mg ratio inversely correlated with QTd duration. Conclusions: (1) RAS inhibition reduces prolonged QTd in HD patients. (2) In PBMC from ordinarily Ca-depleted HD patients, RAS suppression brings about elevation of total intracellular Ca. (3) RAS blockade decreases high intracellular Mg in PBMC from HD patients. Consequently, the Ca/Mg ratio increases, inversely correlating with QTd reduction.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Blockade of Renin-Angiotensin System Reduces QT Dispersion and Improves Intracellular Ca/Mg Status in Hemodialysis Patients

Averbukh¹,

Berman²,

Efrati³

et al. 2006

Nephron Clin Pract

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“…Second, the typical ESRD patient has a cluster of cardiovascular conditions and other co-morbidities, such as diabetes, that makes it very difficult to determine the role of other potential factors, such as electrolyte gradients, in post-dialysis QT interval alterations, beyond that attributable to the underlying cardiac disorder. Most studies on the effects of HD in QT interval parameters in ESRD showed increases in QT interval duration or dispersion [3,10,13,15,19,22,34]. Some others observed variable responses during HD, either no change, slightly decreased or increased QT interval parameters [9,23,27].…”

mentioning

confidence: 99%

QT?interval parameters in end?stage renal disease

Cardoso

Salles

2004

Clin Auton Res

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Cardiac Repolarization Abnormalities Among Patients With Various Stages of Chronic Kidney Disease

Sherif

Abo-Salem

Panikkath

et al. 2014

Clinical Cardiology

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Background Patients with chronic kidney disease (CKD) are at increased risk of life‐threatening cardiovascular arrhythmias. Although these arrhythmias are usually secondary to structural heart diseases that are commonly associated with CKD, a significant proportion of cases with sudden cardiac death have no obvious structural heart disease. This study aims to explore the relationship of cardiac repolarization in patients with CKD and worsening kidney function. Hypothesis There is cardiac repolarization abnormalities among patients with chronic kidney disease. Methods This was a retrospective, chart‐review study of admissions or clinic visits to a university hospital between 2005 and 2010 by patients with a diagnosis of CKD. Inclusion criteria selected patients who had 12‐lead surface electrocardiography (ECG), renal function tests within 24 hours, and transthoracic echocardiography within 6 months. Cases with a documented etiology for the corrected Qt (Qtc) interval prolongation including structural heart disease, QT prolonging drugs, or relevant disease conditions, were excluded. Results Our sample size was 154 ECGs. Two‐thirds of patients with CKD had QTc interval prolongation, and about 20% had a QTc interval >500 ms. QTc interval was significantly different and increased with each successive stage of CKD using the Bazett (P < 0.006) or Fridericia (P = 0.03) formula. QTc interval correlated significantly with serum creatinine (P = 0.01). These finding were independent of age, gender, potassium, and calcium concentrations. Conclusions The progression of CKD resulted in a significant delay of cardiac repolarization, independent of other risk factors. This effect may potentially increase the risk of sudden cardiac death, and may also increase the susceptibility of drug‐induced arrhythmia.

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Cell-associated magnesium and QT dispersion in hemodialysis patients

Cited by 17 publications

References 36 publications

Blockade of Renin-Angiotensin System Reduces QT Dispersion and Improves Intracellular Ca/Mg Status in Hemodialysis Patients

Blockade of Renin-Angiotensin System Reduces QT Dispersion and Improves Intracellular Ca/Mg Status in Hemodialysis Patients

QT?interval parameters in end?stage renal disease

Cardiac Repolarization Abnormalities Among Patients With Various Stages of Chronic Kidney Disease

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