QT Prolongation in Dialysis Patients: An Epidemiological Study with a Focus on Malnutrition

Abstract

<b><i>Background/Aims:</i></b> QT prolongation is a known risk factor for ventricular fibrillation and ventricular tachycardia. Therefore, more refined management is necessary to reduce sudden cardiac death secondary to such arrhythmias. <b><i>Methods:</i></b> Electrocardiographic findings were reviewed in 224 patients, and the associations of QT prolongation with various clinical parameters were examined, including the nutritional state. Correlations were also examined between QT prolongation and body composition measurements determined by multifrequency bioelectrical impedance analysis. <b><i>Results:</i></b> Prolongation of the corrected QT (QTc) interval over 0.44 s was seen in 140 patients (62.5%). QT prolongation was independent of age and dialysis therapy duration and was more frequent in diabetics (70.1%) than in nondiabetics (54.2%, <i>p</i> = 0.014) and more frequent in women (78.8%) than in men (53.5%, <i>p</i> < 0.001). Serum levels of albumin (<i>p</i> < 0.001) and Cr (<i>p</i> < 0.001) and the Geriatric Nutritional Risk Index (GNRI, <i>p</i> < 0.001) were negatively correlated with QTc interval; no significant correlation was noted with total protein, urea nitrogen, or uric acid. Negative correlations with QTc interval were found for BMI(<i>p</i> < 0.01), percent total body water (%TBW; <i>p</i> < 0.05), and percent intracellular water (%ICW; <i>p</i> < 0.01) but not with the percent extracellular water/TBW ratio or edema ratio. The longer the QTc interval, the lower the fat-free mass (FFM; <i>p</i> < 0.01) and muscle mass (MM; <i>p</i> < 0.01), but there was no significant correlation with percent fat. <b><i>Conclusion:</i></b> These results suggest that QT prolongation is a common complication and is more frequent in women and diabetic patients. The decreases in serum albumin and Cr levels, GNRI, BMI, %TBW, %ICW, FFM, and MM together coincided with malnutrition and thus suggest a close relationship of QT prolongation with malnutrition. Management of QT prolongation may be achieved better in the future by understanding these biochemical and biophysical changes, particularly those regarding malnutrition.

The incidence and influencing factors of prolonged QTc interval in patients with HBV-ACLF.

“…In our study, it showed a signi cant negative correlation between QTc interval and serum CRE level (p < 0.019; Table 4), where the higher serum the CRE level, the longer the QTc interval with no sex difference. Which is consistent with our study results 31 .…”

Bioelectrical Impedance Phase Angle Value and Prolongations of PR and Corrected QT Intervals in Patients Undergoing Dialysis

“…In order to understand the sex- and disease-specific results, we examined the relationship between GNRI and both phase angle value and QTc. GNRI is a representative nutritional marker that was correlated with both phase angle value [8, 11, 12] and QTc [19]. The relationships of GNRI, both with phase angle value and QTc, were stronger in males and nondiabetic patients than in females and diabetic patients in our study (Fig.…”

Corrected QT Interval and Outcomes of Dialysis Patients with Symptomatic Peripheral Artery Disease: A Prospective Cohort Study

“…Wu et al revealed that a lower serum albumin concentration was independently associated with QTc prolongation in a cohort of 1383 consecutive patients coexisting with CAD and CKD [15]. Shibata et al also demonstrated serum albumin was negatively associated with QTc interval in a cohort of 224 dialysis patients [16]. Moreover, they found a longer QTc interval negatively associated with lower serum creatinine, worse nutritional status assessed by the Geriatric Nutritional Risk Index, and lesser muscle mass, suggesting the association between malnutrition and QTc prolongation.…”