Progressive loss in circulating volume during haemodialysis can be monitored by time voltage integral area of QRS complex: pilot study

Curione, Mario; Castro, Claudia; Cammarota, Camillo; Tonnarini, Gianfranco; Pasquali, Marzia

doi:10.5114/aoms.2013.34443

Cited by 4 publications

(5 citation statements)

References 7 publications

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“…Mortality risk in hemodialysis patients remains elevated and is mostly linked with cardiovascular complication and infection [ 167 , 168 ]. A better strategy to recognize those patients with increase risk of death is desirable.…”

Section: Dialysismentioning

confidence: 99%

Lipids, blood pressure and kidney update 2015

et al. 2015

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The most important studies and guidelines in the topics of lipid, blood pressure and kidney published in 2015 were reviewed. In lipid research, the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) trial revalidated the concept “lower is better” for low density lipoprotein (LDL)-cholesterol as a target for therapy, increasing the necessity of treatment the high-risk patients to achieve LDL-C goals. After these results, ezetimibe might become the preferred additional drug in the combination therapy of lipid disorders because of oral dosage form and lower acquisition cost. However, for the statin-intolerant patients and those patients requiring essential reductions in LDL-C to achieve their goals, new therapies, including PCSK9 inhibitors remain promising drugs. In blood pressure research, American Heart Association (AHA)/American College of Cardiology (ACC) 2015 guidelines recommended a target for blood pressure below 140/90 mmHg in stable or unstable coronary artery disease patients and below 150/90 mmHg in patients older than 80 years of age, however the recent results of the Systolic Blood Pressure Intervention Trial (SPRINT) trial have suggested that there might be significant benefits, taking into account cardiovascular risk, for hypertensive patients over 50 without diabetes and blood pressure levels <120/80. In kidney research, reducing the progression of chronic kidney disease and related complications such as anemia, metabolic acidosis, bone and mineral diseases, acute kidney injury and cardiovascular disease is still a goal for clinicians.

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Section: Dialysismentioning

confidence: 99%

Lipids, blood pressure and kidney update 2015

et al. 2015

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“…They integrate the previous ones obtained on the R waveCurione et al [2008], thus confirming the relationship between electrocardiographic and hemodynamic variables in normals. This relationship was observed in some clinical experimental conditions in which endoventricular volume progressively changes, such as during haemodialysis Curione et al [2013].…”

Section: Pc1 (971) − Pc2 (22)mentioning

confidence: 62%

Trend Extraction in Functional Data of Amplitudes of R and T Waves in Exercise Electrocardiogram

Cammarota

Curione²

2017

Fluct. Noise Lett.

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The R and T waves amplitudes of the electrocardiogram recorded during the exercise test undergo strong modifications in response to stress. We analyze the time series of these amplitudes in a group of normal subjects in the framework of functional data, performing reduction of dimensionality, smoothing and principal component analysis. These methods show that the R and T amplitudes have opposite responses to stress, consisting respectively in a bump and a dip at the early recovery stage. We test these features computing a confidence band for the trend of the population mean and analyzing the zero crossing of its derivative. Our findings support the existence of a relationship between R and T wave amplitudes and respectively diastolic and systolic ventricular volumes.

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“…Here, we proposed univariable and multivariable [K + ] and [Ca 2+ ] estimators that included information from the whole morphology of the QRS complex. By accounting for characteristics beyond QRS amplitude and width, these estimators could offer more robust performance for ambulatory monitoring of ESRD patients and overcome some limitations of previously proposed markers, such as their dependence on blood volume [36,37].…”

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

confidence: 99%

“…Similarly to QT studies, research on QRS complex duration has rendered inconsistent results, with some works reporting widened QRS complexes [1,34] and others reporting narrowed QRS complexes at high [K + ] [2,35]. Other works have assessed the time voltage area, amplitude and sine wave shape of the QRS complex, but limitations in terms of their significance or their dependence on blood volume have been acknowledged [14,[36][37][38]. None of these studies have, however, quantitatively characterized overall variations in the morphology of the QRS complex during HD.…”

Section: Introductionmentioning

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

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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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Progressive loss in circulating volume during haemodialysis can be monitored by time voltage integral area of QRS complex: pilot study

Cited by 4 publications

References 7 publications

Lipids, blood pressure and kidney update 2015

Lipids, blood pressure and kidney update 2015

Trend Extraction in Functional Data of Amplitudes of R and T Waves in Exercise Electrocardiogram

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

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