Haemodialysis increases QTc interval but not QTc dispersion in ESRD patients without manifest cardiac disease

Covic, Adrian; Diaconita, Mirela; Gusbeth‐Tatomir, Paul; Cović, M; Botezan, Adrian; Ungureanu, G; Goldsmith, David

doi:10.1093/ndt/17.12.2170

Cited by 99 publications

(90 citation statements)

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“…28 Electrocardiogram data demonstrate that the risk of arrhythmia could be higher with decreased plasma Na, K, and decreased ionized Ca during HD. 29 A study showed that hemodialysis increases the QTc interval in ESRD patients, mainly because of rapid changes in plasma electrolyte concentrations 16,30 ; another study indicated that there was no correlation between the changes in QTd and the changes in serum cations. However, the change in QTc correlated inversely with the change in serum calcium level.…”

Section: Discussionmentioning

confidence: 99%

QT Intervals in Patients Receiving a Renal Transplant

Monfared

Z²,

Salari³

et al. 2012

Exp Clin Transplant

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Objectives: Cardiovascular disease is the mostcommon cause of mortality in patients with endstage renal disease and renal transplant. Prolongation of QTc max and QTc dispersion are risk factors of cardiac arrhythmias and mortality. This study compares the changes of QT parameters before hemodialysis, after hemodialysis, and after renal transplant. Materials and Methods: Patient candidates for renal transplant were selected. Mean serum electrolyte and 12-lead electrocardiogram were recorded (1) immediately, (2) before and, (3) after the last dialysis session before renal transplant, (4) and 2 weeks after a kidney transplant in 34 patients with normal graft function (plasma Cr ≤ 176.8 µmol/L). Each QT interval was corrected for the patient's heart rate using Bazett's formula. The QT parameters (QTd, QTcd, QTc max ) were compared between prehemodialysis, posthemodialysis, and 2 weeks after renal transplant using a paired t test and a general liner model repeated measure. The correlation between QT parameter changes and serum electrolyte and acidbase alternation was analyzed. Results: The corrected maximal QT interval (QTc max ) decreased significantly after successful renal transplant compared to prehemodialysis (P = .002) and posthemodialysis (P = .003) with a paired t test and a General Liner Model Repeated Measure (P < .001) between the 3 groups. Also, the mean of

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Section: Discussionmentioning

confidence: 99%

QT Intervals in Patients Receiving a Renal Transplant

Monfared

Z²,

Salari³

et al. 2012

Exp Clin Transplant

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“…27 Prior reports have attributed these abnormalities to the high prevalence of LVH and electrolyte imbalance, 21 while others have suggested that they could be related to dialysis, because the QTc has been shown to prolong after dialysis. 28,29 None of these reports have accounted for the presence and/or severity of CAD.…”

Section: Discussionmentioning

confidence: 99%

QT Prolongation Is an Independent Predictor of Mortality in End‐Stage Renal Disease

Hage

Mattos

Khamash

et al. 2010

Clinical Cardiology

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Background: Coronary artery disease (CAD) is the predominant cause of sudden cardiac death in the general population, and sudden cardiac death is the leading cause of mortality in end-stage renal disease (ESRD). Hypothesis: QT-interval prolongation is an independent prognosticator in ESRD. Methods: We reviewed clinical, electrocardiographic, stress test, and coronary angiography data on ESRD patients evaluated for transplantation at our institution between 2000 and 2004 who underwent coronary angiography. The QT interval was corrected for heart rate and QRS duration (QTc). All-cause mortality data were prospectively collected and verified against the Social Security Death Index database. Results: During 40 ± 28 months of follow-up, 132 of the 280 (47%) patients died prior to renal transplantation. Patients with a prolonged QTc (39%) had 1-, 3-, and 5-year death-rates of 12%, 36%, and 47%, respectively, vs 8%, 24%, and 36% for those with normal QTc (log-rank P = 0.03). In a multivariate Cox regression model that adjusted for age, gender, diabetes mellitus, myocardial infarction, presence and severity of CAD on angiography, left ventricular (LV) hypertrophy, LV ejection fraction (EF), and multiple other variables, QTc remained to be an independent predictor of survival (hazard ratio [HR]: 1.008, 95% confidence interval [CI]: 1.001-1.014, P = 0.016). Female gender, decreasing LVEF, and decreasing severity of CAD on angiography were independent predictors of prolonged QTc. Conclusions: QTc prolongation is an independent predictor of mortality in ESRD patients being evaluated for renal transplantation. The prognostic information gained from the QTc is additive to that provided by the LVEF and the severity of CAD.

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“…Although ECGs are extensively used diagnostic tools, appropriate systematic evaluations regarding the prognostic utility in hemodialysis patients are absent. This is of particular importance, since in this high-risk group ECG interpretation might be compromised by the fact that volume and electrolyte status can influence various ECG variables like the QRS complex, QT interval and P-wave (3,4,5,6).…”

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confidence: 99%

Electrocardiography and Outcome in Patients with Diabetes Mellitus on Maintenance Hemodialysis

Krane

Heinrich²,

Meesmann³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: In hemodialysis, applicable guidelines recommend regular electrocardiogram (ECG) recordings.However, respective systematic evaluations are absent. Thus, the authors investigated whether routine ECG findings add prognostic information to standard risk assessment in hemodialysis.Design, setting, participants, & measurements: The relationship between nine common baseline ECG variables and a combined cardiovascular endpoint (CVE; cardiac death, myocardial infarction, stroke), sudden death, stroke, MI, and all-cause death in 1253 patients from the German Diabetes and Dialysis Study was evaluated. All patients were on maintenance hemodialysis, had type 2 diabetes mellitus, and received randomized treatment with atorvastatin or placebo.Results: During 4 yr of follow-up (March 1998 to March 2004), 469 patients reached the CVE, and 617 died. After adjustment for demographics, comorbidities, and biomarkers in multivariate analysis, patients presenting without sinus rhythm were 89% more likely to die, and the risk of CVE and stroke increased by 75% and 164%, respectively, compared with patients with preserved sinus rhythm. Left ventricular hypertrophy was associated with >2-fold increase in the risk of stroke and a 60% increase in the risk of sudden death.Conclusions: In hemodialysis patients with type 2 diabetes mellitus, the absence of sinus rhythm is a risk indicator for CVE, stroke, and all-cause death, and left ventricular hypertrophy is associated with stroke and sudden death. Thus, routine ECG recording adds prognostic information to standard risk assessment.

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Haemodialysis increases QTc interval but not QTc dispersion in ESRD patients without manifest cardiac disease

Abstract: Haemodialysis increases the QTc interval in ESRD patients, mainly related to rapid changes in electrolyte plasma concentrations. However, the impact on QTc dispersion is less important in the absence of significant coexisting cardiac disease.

Cited by 99 publications

References 0 publications

QT Intervals in Patients Receiving a Renal Transplant

QT Intervals in Patients Receiving a Renal Transplant

QT Prolongation Is an Independent Predictor of Mortality in End‐Stage Renal Disease

Electrocardiography and Outcome in Patients with Diabetes Mellitus on Maintenance Hemodialysis

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