Estimation of potassium levels in hemodialysis patients by T wave nonlinear dynamics and morphology markers

Bukhari, Hassaan; Sánchez, Carlos; Srinivasan, Sabarathinam; Palmieri, Flavio; Potse, Mark; Laguna, Pablo; Pueyo, Esther

doi:10.1016/j.compbiomed.2022.105304

Cited by 5 publications

(15 citation statements)

References 43 publications

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“…These studies, however, have not established a tight correlation between the proposed markers and [K + ], thus limiting their possibilities for ambulatory [K + ] monitoring. In previous studies, we used nonlinear dynamics and time-warping techniques to characterize changes in the whole T wave at varying [K + ] and [Ca 2+ ] in patients and simulated ECGs [28][29][30][31][32][33]. We found a strong relationship between [K + ] and T wave linear and nonlinear features.…”

Section: Introductionmentioning

confidence: 86%

“…A number of studies have characterized changes in T wave width, amplitude, slope or slope-to-amplitude ratio [10,11,13,49,50]. We have recently quantified changes in T wave nonlinear dynamics and morphology and have shown their relationship with [K + ] and [Ca 2+ ] variations [28,29,31,33,51].…”

Section: Characterization Of Qrs Complex Amplitude Duration and Morph...mentioning

confidence: 99%

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Monitoring of Serum Potassium and Calcium Levels in End-Stage Renal Disease Patients by ECG Depolarization Morphology Analysis

Bukhari

Sánchez

Ruiz

et al. 2022

Sensors

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Objective: Non-invasive estimation of serum potassium, [K+], and calcium, [Ca2+], can help to prevent life-threatening ventricular arrhythmias in patients with advanced renal disease, but current methods for estimation of electrolyte levels have limitations. We aimed to develop new markers based on the morphology of the QRS complex of the electrocardiogram (ECG). Methods: ECG recordings from 29 patients undergoing hemodialysis (HD) were processed. Mean warped QRS complexes were computed in two-minute windows at the start of an HD session, at the end of each HD hour and 48 h after it. We quantified QRS width, amplitude and the proposed QRS morphology-based markers that were computed by warping techniques. Reference [K+] and [Ca2+] were determined from blood samples acquired at the time points where the markers were estimated. Linear regression models were used to estimate electrolyte levels from the QRS markers individually and in combination with T wave morphology markers. Leave-one-out cross-validation was used to assess the performance of the estimators. Results: All markers, except for QRS width, strongly correlated with [K+] (median Pearson correlation coefficients, r, ranging from 0.81 to 0.87) and with [Ca2+] (r ranging from 0.61 to 0.76). QRS morphology markers showed very low sensitivity to heart rate (HR). Actual and estimated serum electrolyte levels differed, on average, by less than 0.035 mM (relative error of 0.018) for [K+] and 0.010 mM (relative error of 0.004) for [Ca2+] when patient-specific multivariable estimators combining QRS and T wave markers were used. Conclusion: QRS morphological markers allow non-invasive estimation of [K+] and [Ca2+] with low sensitivity to HR. The estimation performance is improved when multivariable models, including T wave markers, are considered. Significance: Markers based on the QRS complex of the ECG could contribute to non-invasive monitoring of serum electrolyte levels and arrhythmia risk prediction in patients with renal disease.

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Section: Introductionmentioning

confidence: 86%

Section: Characterization Of Qrs Complex Amplitude Duration and Morph...mentioning

confidence: 99%

Monitoring of Serum Potassium and Calcium Levels in End-Stage Renal Disease Patients by ECG Depolarization Morphology Analysis

Bukhari

Sánchez

Ruiz

et al. 2022

Sensors

Self Cite

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“…81 Research in this area is ongoing; scientists are developing various algorithms in order to estimate blood potassium levels from ECG signals. 77,82,83 To date, the accuracy needed for clinical and diagnostic purposes has not been demonstrated in significant numbers of human subjects using this method.…”

Section: Non-invasive and Indirect Potassium Detectionmentioning

confidence: 99%

Point-of-care and self-testing for potassium: recent advances

Hutter

Collings²,

Kostova³

et al. 2022

Sens. Diagn.

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“…Some of the proposed T wave markers evaluated durations and slopes of the T wave or portions of it [3]. In previous studies, we investigated T wave morphology markers by using time-warping and nonlinear dynamics techniques [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…We observed large inter-patient variability in T wave morphology in response to [K + ] and [Ca 2+ ] variations [4][5][6]. Here, we hypothesized that evaluation of T wave morphology changes using human-specific torso models could provide relevant information on inter-individual repolarization characteristics.…”

Section: Introductionmentioning

confidence: 99%

Inter-individual Differences in Cell Composition across the Ventricular Wall May Explain Variability in ECG Response to Serum Potassium and Calcium Variations

Bukhari¹,

Sánchez²,

Laguna³

et al. 2022

Computing in Cardiology Conference (CinC)

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Non-invasive monitoring of serum potassium ([K + ]) and calcium ([Ca 2+ ]) concentration can help to prevent arrhythmia in kidney patients. Current electrocardiogram (ECG) markers, including the T wave width (T w ) and its time-warped temporal morphological variability (d U w ), correlate significantly with [K + ] and [Ca 2+ ] but these relations vary strongly between patients. We hypothesized that inter-individual differences in cell type distribution across the ventricular wall can explain this variability.We computed T w and d U w in simulated ECGs from a human heart-torso model at different proportions of endo-, mid-, and epicardial cells, while varying [K + ] (3 to 6.2 mM) and [Ca 2+ ] (1.4 to 3.2 mM). Electrical activity was simulated with a reaction-diffusion model with modified Ten Tusscher-Panfilov dynamics. Results were compared to data from 29 patients.T w and d U w correlated strongly with [K + ] (absolute median Pearson coefficient r = 0.70 to 0.93) and [Ca 2+ ] (r = 0.69 to 0.86) in simulations and in patients. Different cell type distributions reproduced inter-patient variability, with the same sign and magnitude of r.In conclusion, the inter-patient variability in the relation between serum electrolytes and their ECG markers can indeed be explained by inter-individual differences in cell type distribution across the ventricular wall.

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Estimation of potassium levels in hemodialysis patients by T wave nonlinear dynamics and morphology markers

Cited by 5 publications

References 43 publications

Monitoring of Serum Potassium and Calcium Levels in End-Stage Renal Disease Patients by ECG Depolarization Morphology Analysis

Monitoring of Serum Potassium and Calcium Levels in End-Stage Renal Disease Patients by ECG Depolarization Morphology Analysis

Point-of-care and self-testing for potassium: recent advances

Inter-individual Differences in Cell Composition across the Ventricular Wall May Explain Variability in ECG Response to Serum Potassium and Calcium Variations

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