P Wave Dispersion Increases during Hemodialysis Sessions

Özben, Beste; Toprak, Ahmet; Koç, Mehmet; Sumerkan, M.C.; Tanrikulu, Azra Meryem; Papila-Topal, Nurdan; Kefeli, U.; Cincin, Altug; Baykan, Özgür; Fak, Ali Serdar

doi:10.1159/000214213

Cited by 14 publications

(14 citation statements)

References 31 publications

(26 reference statements)

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“…P-wave dispersion increases significantly during dialysis and may increase the risk of intermittent intradialytic AF episodes. An increased risk of P-wave abnormalities is related to UFR and electrolyte changes [38]. Based on data from a prospective study of implantable defibrillators in HD patients, the prevalence of paroxysmal AF was threefold higher on dialysis days and specifically increased during the dialysis procedure itself [4].…”

Section: Discussionmentioning

confidence: 99%

Association of Central Venous Oxygen Saturation Variability and Mortality in Hemodialysis Patients

et al. 2018

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Background: Central venous oxygen saturation (ScvO₂) is correlated with cardiac output. In most patients, ScvO₂ declines during hemodialysis (HD) due to factors such as reduced preload, myocardial stunning, and intermittent arrhythmias. Previous research has shown that low ScvO₂ is associated with higher mortality in chronic HD patients. In this research, we tested the hypothesis that ScvO₂ variability is associated with all-cause mortality. Methods: We conducted a retrospective study in 232 chronic HD patients with central venous catheter as vascular access. ScvO₂ was recorded 1× per minute during dialysis using the Crit-Line monitor. A 6-month baseline comprising at least 10 dialysis treatments with ScvO₂ recordings preceded a follow-up period of up to 3 years. The coefficient of variation (CV) of ScvO₂ (100 times the ratio of the standard deviation and mean of ScvO₂) served as a measure of ScvO₂ stability during baseline. Patients were stratified by median population CV of ScvO₂ during baseline, and survival during follow-up was compared between the 2 groups by Kaplan Meier and multivariate Cox analysis. The association between CV of ScvO₂ and all-cause mortality during follow-up was further assessed by Cox analysis with a spline term for CV of ScvO₂. Results: The mean CV ± standard deviation of ScvO₂ in our population was 6.1 ± 2.7% and the median was 5.3%. Univariate Kaplan-Meier analysis (p = 0.043) and multivariate Cox analysis (hazard ratio [HR] 1.16; p = 0.0005) indicated that a CV of ScvO₂ > 5.3% was significantly associated with increased mortality. In Cox analysis with spline term, a CV of ScvO₂ > 11% was associated with a significantly increased HR for all-cause mortality. Conclusion: High ScvO₂ variability during dialysis is associated with increased all-cause mortality.

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Section: Discussionmentioning

confidence: 99%

Association of Central Venous Oxygen Saturation Variability and Mortality in Hemodialysis Patients

et al. 2018

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“…Predialysis P dispersion of 23 (10) ms significantly increased to 41 (16) ms by the end of the sessions (P < .0001). Ozben et al [20] recorded the results of electrocardiograms immediately before, at the end of the second hour, and at the end of the dialysis sessions. They also found that P wave dispersion significantly increased during hemodialysis sessions, with means of 41 (12) ms and 21 (10) ms before and at the end of dialysis, respectively (P < .001).…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic Changes in Patients Undergoing Hemodialysis

Salari¹,

Mokhtari²,

Mirbolook³

et al. 2010

UIJ

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Abbreviations and AcronymsECG = electrocardiography or electrocardiogram QRS-c = QRS complex QTc = QT interval corrected for heart rate QTD = QT dispersion ABSTRACT INTRODUCTION: Patients with end-stage renal disease who are on long-term dialysis support have a very high mortality. Nearly half of deaths on dialysis are secondary to myocardial infarction, cardiac arrest, malignant arrhythmias, and other cardiac causes. The purpose of the present study was to compare electrocardiogram (ECG) disturbances before and after hemodialysis. METHODS:The participants were 144 patients on dialysis who met specific inclusion criteria. Their mean (SD) age was 56.27 (14.2) years. A cross-sectional study was conducted between June and December, 2009. Twelve-lead ECGs were performed in identical conditions for all patients, 10 minutes before and 10 minutes after the midweek morning hemodialysis session. Duration and amplitude of P wave and QRS complex, and duration of QTc and QTd were calculated. ECGs were analyzed by a single observer who was blind to all patient information. The Kolmogorov Smirnov, Wilcoxon signed rank, and McNemar tests were used to compare the variables before and after hemodialysis. RESULTS:The mean duration of the QRS complex and QTc were significantly higher after dialysis (P = .043 and P = .007, respectively). There were no significant differences in the mean P wave duration or mean QTd (P > .05).There was a significant increase in the mean P wave and QRS complex amplitudes after hemodialysis (P = .0001).There were no significant differences between the number of patients with normal and abnormal values before and after dialysis for the duration of QRS complex, P wave, QTc, or QTd, or the amplitude of the P wave and QRS. CONCLUSIONS:In the present study, ECG changes before and after hemodialysis presented as a significant increase in duration and amplitude of QRS, amplitude of P wave, and duration of QTc. ECG changes, especially QT intervals, should be monitored in patients with a history of hemodialysis in order to decrease cardiac complications. UroToday International Journal ® UI J

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“…However, in one study, P-wave duration decreased and root mean square voltage of the final 20 ms of the filtered P wave decreased from the beginning to the end of dialysis, changes suggesting a reduced risk of AF after HD (53). Changes in electrolytes were associated with P-wave parameters in several studies (51,52), but associations with ultrafiltration appear more robust (50,51). On balance, this literature suggests that rapid ultrafiltration or other factors during HD acutely affect conduction in a way that could trigger AF but that effects rapidly attenuate after HD.…”

Section: Dialysis As a Triggermentioning

confidence: 92%

“…Similarly, there are peridialytic changes in P-wave dispersion (standard electrocardiography), P-wave duration, and the root mean square voltage of the final 20 ms of the filtered P wave (signal-averaged electrocardiography)-parameters that measure atrial conduction delay and are associated with AF (48,49). In several studies, intradialytic changes were prominent and were attenuated at the conclusion of dialysis (50,51). In others, changes were not detected or were seen only at the conclusion of dialysis and then quickly attenuated (52).…”

Section: Dialysis As a Triggermentioning

confidence: 99%

Arrhythmia and Sudden Death in Hemodialysis Patients

Charytan

Foley

McCullough

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background Dialysis patients have high rates of cardiovascular morbidity and mortality, but data on arrhythmia burden, arrhythmia type, arrhythmia triggers, and the identity of terminal arrhythmias have historically been limited by an inability to monitor heart rhythm for prolonged periods.Objectives To investigate arrhythmia and its association with sudden death in dialysis-dependent ESRD, describe the potential for implantable devices to advance study of dialysis physiology, review the ethical implications of using implantable devices in clinical studies, and report on the protocol and baseline results of the Monitoring in Dialysis Study (MiD).Design, setting, participants, & measurements In this multicenter, interventional-observational, prospective cohort study, we placed implantable loop recorders in patients undergoing long-term hemodialysis. The proportion of patients experiencing clinically significant arrhythmias was the primary endpoint. For 6 months, we captured detailed data on the primary endpoint, symptomatic arrhythmias, other electrocardiographic variables, dialysis prescription, electrolytes, dialysis-related variables, and vital signs. We collected additional electrocardiographic data for up to 1 year.Results Overall, 66 patients underwent implantation in sites in the United States and India. Diabetes was present in 63.6% of patients, 12.1% were age $70 years, 69.7% were men, and 53.0% were black. Primary and secondary endpoint data are expected in 2016.Conclusions Cardiac arrhythmia is an important contributor to cardiovascular morbidity and mortality in dialysis patients, but available technology has previously limited the ability to estimate its true burden and triggers and to define terminal rhythms in sudden death. Use of implantable technology in observational studies raises complex issues but may greatly expand understanding of dialysis physiology. The use of implantable loop recorders in MiD is among the first examples of such a trial, and the results are expected to provide novel insights into the nature of arrhythmia in hemodialysis patients.

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P Wave Dispersion Increases during Hemodialysis Sessions

Cited by 14 publications

References 31 publications

Association of Central Venous Oxygen Saturation Variability and Mortality in Hemodialysis Patients

Association of Central Venous Oxygen Saturation Variability and Mortality in Hemodialysis Patients

Electrocardiographic Changes in Patients Undergoing Hemodialysis

Arrhythmia and Sudden Death in Hemodialysis Patients

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