QTc dispersion increases during hemodialysis with low-calcium dialysate

Näppi, Satu; Virtanen, Vesa; Saha, Heikki; Mustonen, Jukka; Pasternack, Amos

doi:10.1046/j.1523-1755.2000.00062.x

Cited by 119 publications

(121 citation statements)

References 28 publications

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“…Both electrographic abnormalities have been shown to be independent risk factors of increased cardiovascular mortality in patients with preexisting cardiovascular diseases (15). Hypocalcemia may thus predispose to ventricular arrhythmias and sudden death, especially in cardiovascularvulnerable patients (16,17).…”

Section: Discussionmentioning

confidence: 99%

Calcium Metabolism in the Early Posttransplantation Period

Evenepoel

Bergh²,

Naesens³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Information on the time course of serum calcium levels after renal transplantation is scanty, especially in the early posttransplantation period. Both the abrupt cessation of calcium-containing phosphorus binders and vitamin D (analogs) at the time of surgery and the recovery of renal function may be hypothesized to affect serum calcium levels in this period.Design, setting, participants, & measurements: In this prospective observational study, biointact parathyroid hormone, calcidiol, calcitriol, calcium, and phosphorus levels were monitored in 201 renal transplant recipients at the time of transplantation and 3 mo thereafter. In addition, the serum calcium nadir and peak in each individual patient within this time frame were identified and the urinary fractional calcium excretion was determined at month 3.Results: Serum calcium levels followed a biphasic pattern with a significant decline during the first postoperative week, followed by a significant increase. High pretransplantation parathyroid hormone levels protect against hypocalcemia within the first postoperative week but put patients at risk for hypercalcemia later. These complications, occurring in 41 and 14% of the patients, respectively, most probably reflect inappropriate calcium release from the skeleton, rather than inappropriate renal calcium handling.Conclusions: Our data indicate that both hypo-and hypercalcemia are prevalent in the early posttransplantation period. Pretransplantation parathyroid function is an important predictor of posttransplantation calcium levels.

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Section: Discussionmentioning

confidence: 99%

Calcium Metabolism in the Early Posttransplantation Period

Evenepoel

Bergh²,

Naesens³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…Several studies have reported that the ventricular arrhythmia, sudden and cardiac deaths are relatively frequent in HD patients (16). QTc dispersion (QTcd) were defi ned as the differences between the minimal and maximal QTc values in each of the 12 leads studied and refl ects differences in ventricular recovery times (17).…”

Section: Discussionmentioning

confidence: 99%

“…It is suggested that in the heart, iron deposition is not homogeneous, greatest amount of iron collects in the left side of the ventricular septum and free wall and may contribute to the arrhythmogenecity (29,30). Iron overload in dialysis patients induces arrhythmias, which may be measured by the surrogate marker of QTc dispersion (31) A study in which different dialysate calcium (1.25, 1.5 and 1.75 mmol⁄ l) was examined by Nappi et al to evaluate the effect of dialysate calcium concentration on cardiac electrical stability during HD treatment in 23 ESRD patients (17). They reported that HD treatments with dialysate Ca ++ concentrations of 1.25 mmol/L was the only procedure that induced a signifi cant increase in QTc dispersion (from 38± 19 to 49± 18 ms, p< 0.05).…”

Section: Most Patients With Ckd Have Cardiac Abnormalities Including mentioning

confidence: 99%

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Evaluation of the Frequency of QTc Dispersion and Its Relationship with Clinical and Laboratory Parameters in Dialysis Patients

Yilmaz¹,

Yildirim²,

Yilmaz³

et al. 2013

Turk Neph Dial Transpl

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OBJECTIVE:QTc dispersion is defi ned as the difference between the maximal and minimal correct QT interval on standard 12-lead ECG. Increased QTc dispersion has been reported in ESRD patients. In our study, we aimed to evaluate the frequency of QTc dispersion and its relationship between clinical and laboratory parameters in patients on regular dialysis programme. MATERIAL and METHODS:Sixty patients underwent dialysis (30 HD, 30 CAPD) and another 30 healthy subjects were enrolled into the study. The standard 12 lead ECGs were performed and QTcd was measured from all dialysis patients and control subjects. Blood samples were collected for the measurement of laboratory parameters. RESULTS:Dialysis patients showed signifi cantly higher QTcd than control subjects (55.75±36.48 versus 28.73±28.27; p=0.001). Patients with QTcd >50 ms had signifi cantly higher SBP, urea and ferritin levels, but signifi cantly lower iron binding capacity and calcium levels compared those with QTcd ≤ 50 ms(p<0.05). Positive correlations were found between QTcd and urea, ferritin and SBP levels, and inverse correlations with iron binding capacity level (p<0.05). CONCLUSION:The frequency of QTc dispersion was 40% among the dialysis patients .Although serum calcium was signifi cantly lower in patients who had QTcd >50 ms than QTcd ≤ 50 ms (p<0.05), there was no signifi cant correlation between QTcd and calcium. KEY WORDS:QTcd, Dialysis patients, Arrhythmia, Electrocardiography, Calcium ÖZ AMAÇ: 12 derivasyonlu standart EKG'de en uzun QTc mesafesi ile en kısa QTc mesafesi arasındaki fark QTc dispersiyonu olarak tanımlanır. SDBY hastalarında artmış QTc dispersiyonu bildirilmiştir. Biz çalışmamızda, diyaliz hastalarında QTc dispersiyonunun sıklığını ve klinik ve laboratuvar parametrelerle ilişkisinin değerlendirilmesini amaçladık. GEREÇ ve YÖNTEMLER:Çalışmaya 60 diyaliz hastası (30 HD, 30 PD) ve 30 sağlıklı birey dahil edildi. Tüm diyaliz hastalarının ve katılımcıların 12 derivasyonlu elektrokardiyografi leri çekildi ve QTcd ölçüldü. Laboratuvar parametreleri için kan örnekleri toplandı.BULGULAR: Diyaliz hastaları kontrol grubundan daha yüksek QTcd'ye sahipti (55,75±36,48 ve 28,73±28,27; p=0.001). QTcd >50 ms olan hastalar QTcd ≤ 50 ms olanlarla karşılaştırıldığında, SKB, üre ve ferritin anlamlı olarak daha yüksek, Ca ve demir bağlama kapasitesi anlamlı olarak daha düşüktü (p<0,05). QTcd ile üre, ferritin, SKB arasında pozitif, demir bağlama kapasitesi arasında ters korelasyon saptandı (p<0,05). SONUÇ:Diyaliz hastaları arasında QTc dispersiyonunun sıklığı %40'tı. QTcd >50 ms olan hastalarda, QTcd ≤ 50 ms olanlardan göre daha düşük serum kalsiyumu olmasına karşın, QTcd ve Ca arasında anlamlı bir korelasyon mevcut değildi.

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“…For many years, we have known that lower calcium dialysate concentrations are associated with a prolongation of the QT interval and QT dispersion (2)-both risk factors for sudden death (3). These changes in cardiac conduction were noted by Näppi et al (2) when the dialysate calcium concentration was decreased from 1.5 mmol/L (3 mEq/L) to 1.25 mmol/L (2.5 mEq/L). The use of a lower calcium dialysate has also been associated with a statistically significant lowering of BP during the dialysis treatment (4).…”

mentioning

confidence: 99%

Clinical Implications of the Relationship between Low Calcium Concentration Dialysate and Sudden Death

Bleyer

2013

Clinical Journal of the American Society of Nephrology

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QTc dispersion increases during hemodialysis with low-calcium dialysate

Cited by 119 publications

References 28 publications

Calcium Metabolism in the Early Posttransplantation Period

Calcium Metabolism in the Early Posttransplantation Period

Evaluation of the Frequency of QTc Dispersion and Its Relationship with Clinical and Laboratory Parameters in Dialysis Patients

Clinical Implications of the Relationship between Low Calcium Concentration Dialysate and Sudden Death

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