Kidney Function, Electrocardiographic Findings, and Cardiovascular Events among Older Adults

Abstract

Chronic kidney disease (CKD) is associated with cardiovascular (CV) disease and mortality. It is not known whether cardiac rhythm disturbances are more prevalent among individuals with CKD or whether resting electrocardiogram findings predict future CV events in the CKD setting. Data were obtained from the Cardiovascular Health Study, a community-based study of adults aged >65 yr. After exclusions for prevalent heart disease, atrial fibrillation, implantable pacemaker, or antiarrhythmic medication use, 3238 participants were analyzed. CKD was defined by an estimated GFR <60 ml/min per 1.73 m 2 . Outcomes were adjudicated incident heart failure (HF), incident coronary heart disease (CHD), and mortality. Participants with CKD had longer PR and corrected QT intervals compared with those without CKD; however, differences in electrocardiographic markers were explained by traditional CV risk factors and CV medication use. After adjustment for known risk factors, each 10-ms increase in the QRS interval was associated with a 15% greater risk for incident HF (95% confidence interval [CI] 1.04 to 1.27), a 13% greater risk for CHD (95% CI 1.04 to 1.24), and a 17% greater risk for mortality (95% CI 1.09, 1.25) among CKD participants. Each 5% increase in QTI was associated with a 42% (95% CI 1.23 to 1.65), 22% (95% CI 1.07 to 1.40), and 10% (95% CI 0.98 to 1.22) greater risk for HF, CHD, and mortality, respectively. Associations seemed stronger for participants with CKD; however, no significant interactions were detected. Resting electrocardiographic abnormalities are common in CKD and independently predict future clinical CV events in this setting.

Electrocardiogram Abnormalities and Cardiovascular Mortality in Elderly Patients with CKD

“…The observed association is consistent with previous reports (3,(10)(11)(12). Left ventricular hypertrophy, intraventricular conduction delay, QT prolongation, wide QRS, and atrial fibrillation are the most common ECG abnormalities studied in the literature in conjunction with CKD (13,21,22).…”

“…Left ventricular hypertrophy, intraventricular conduction delay, QT prolongation, wide QRS, and atrial fibrillation are the most common ECG abnormalities studied in the literature in conjunction with CKD (13,21,22). This study extends the findings of Kestenbaum et al (10), who demonstrated that longer QRS and corrected QT intervals were independently associated with incident heart failure, CAD, and death among participants with early CKD and those without CKD. The analysis in that study focused on conduction abnormalities; therefore, participants with a history of heart failure, CAD, atrial fibrillation, or implantable pacemakers or those who were using class Ia or class IIIa antiarrhythmic medications were excluded.…”

“…Although several studies have examined the cross-sectional association between electrocardiogram (ECG) abnormalities and CKD, there are limited data on the prevalence of ECG abnormalities and their association with longitudinal cardiovascular outcomes in patients with CKD, particularly in the elderly (6,(10)(11)(12)(13)(14)(15). The purpose of our study was to assess the prevalence of significant ECG abnormalities and evaluate their association with subsequent cardiovascular morbidity and mortality in a large cohort of older adults with CKD enrolled in the Cardiovascular Health Study (CHS).…”

Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD

“…In communitybased elderly participants with early CKD, ECG measures were independently associated with all-cause mortality. 6,7 The mean age in these studies was 75 years, the mean eGFR was 50-60 ml/min per 1.73m 2 and greater than 80% of the study population was white thus limiting the generalizability of these findings to a larger CKD population, especially those with moderate to advanced CKD. In contrast, among participants with end stage renal disease on hemodialysis from the German Diabetes and Dialysis (4D) Study, common ECG measures including the QRS duration, QT interval and heart rate were not independently associated with clinical events.…”

Rate versus rhythm control and outcomes in patients with atrial fibrillation and chronic kidney disease: Data from the GUSTO-III Trial

“…The risks of antiarrhythmic therapy may be magnifi ed in patients with CKD, owing to the need for renal dose adjustment of certain antiarrhythmic agents [21], as well as to the co-morbidity that often accompanies CKD and that may promote pro-arrhythmia. The development of fi brosis and left ventricular hypertrophy associated with kidney disease is hypothesized to predispose CKD patients to cardiac arrhythmia and sudden death by its effects on the QT interval and QT dispersion [22,23]. As a result, evidence from clinical trials on rate and rhythm control strategies in AF may not be generalizable to patients with impaired renal function, so data are limited in this regard.…”