The Influence of Hemodialysis on P‐Wave Signal‐Averaged Electrocardiogram Findings

Özcan, Türkay; Horoz, Mehmet; Gençtoy, Gültekin; Uyar, Bulent; Çamsarı, Ahmet; Kıykım, Ahmet

doi:10.1111/j.1525-1594.2007.00433.x

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…P wave duration significantly increased from a beginning mean of 27 (9) ms to an ending mean of 52 (11) ms (P < .001). Ozcan et al [21] showed that predialysis and postdialysis mean P wave dispersions significantly increased in patients undergoing dialysis when compared with control participants, but the mean voltage of predialysis and postdialysis LP20 were significantly reduced (P < .05).…”

Section: Discussionmentioning

confidence: 96%

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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Section: Discussionmentioning

confidence: 96%

Electrocardiographic Changes in Patients Undergoing Hemodialysis

Salari¹,

Mokhtari²,

Mirbolook³

et al. 2010

UIJ

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“…6 Studies of P-wave characteristics on electrocardiograms during hemodialysis point to increased intra-atrial conduction abnormalities developing during the hemodialysis procedure, which correlate with changes in potassium and calcium concentrations during the treatment. 19,20 The Heart and Soul study prospectively studied the relationship between AF and renal function. 21 These patients tended to have preserved renal function; the cutoff point between the middle and lowest tertiles was an estimated glomerular filtration rate (eGFR) of 62 mL/min/1.73 m 2 .…”

Section: The Epidemiology Of Af In Patients With Esrd Compared With Tmentioning

confidence: 99%

Anticoagulants in Patients with Atrial Fibrillation and End-Stage Renal Disease

Brimble¹,

Ingram²,

Eikelboom³

et al. 2012

Postgraduate Medicine

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Atrial fibrillation (AF) is a common cardiac arrhythmia and is associated with an increased risk for thromboembolic stroke. Anticoagulant therapy has been shown to reduce the risk for ischemic stroke in patients with AF; however, these studies have excluded patients with end-stage renal disease (ESRD). This review examines the relationships between ESRD, AF, and the use of anticoagulants to prevent ischemic stroke. Medline and Embase were used to identify relevant articles. Identified review articles and their references were searched. The prevalence of AF in patients with ESRD is higher than that in the general population; ESRD appears to be an independent risk factor for AF. The presence of AF in patients with ESRD increases the risk for stroke, although this effect is less pronounced when compared with the general population. The presence of ESRD confers an increased risk for bleeding; warfarin appears to enhance this risk. Observational data suggest that warfarin increases the rate of hemorrhagic stroke in patients with ESRD, but are unclear on its utility in reducing ischemic stroke. In addition to increasing the risk for bleeding, warfarin may also promote vascular calcification in this population. Currently, there are no oral anticoagulants other than warfarin that are approved for use in patients with ESRD. Recent guidelines suggest that warfarin only be used for secondary prevention in patients with ESRD and AF. Randomized controlled trials are needed to clarify the role of warfarin or other anticoagulants in preventing stroke in patients with ESRD and AF.

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“…These variations, especially dispersion of the QT interval caused by so-called ''late potentials,'' initially were purported to predict reentrant arrhythmias in patients with ischemic heart disease or cardiomyopathy (15). A number of studies (16)(17)(18)(19)(20)(21)(22) have applied this method to patients undergoing hemodialysis to understand the dialysis-associated risk for cardiac arrhythmias. With one exception (18), all studies showed an increase in late potentials in patients during hemodialysis (16,17,(19)(20)(21)(22).…”

Section: Indirect Evidence: Surrogate Outcomesmentioning

confidence: 99%

The Safety of Low‐Potassium Dialysis

Weisberg

Rachoin

2010

Seminars in Dialysis

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Patients with kidney failure depend on dialysis to maintain neutral potassium balance. The amount of potassium removed during a hemodialysis treatment is inversely proportional to the potassium concentration in the dialysis bath. Nephrologists adjust the dialysis bath potassium to account for individual variation in potassium intake among their patients. This management strategy is remarkably successful, because most patients on maintenance hemodialysis have a normal predialysis serum potassium concentration. But the serum potassium concentration of patients on maintenance hemodialysis is not constant over time; it follows a sawtooth pattern. It is this instability--especially the acute fall during dialysis--that has concerned nephrologists for decades, particularly in view of the crucial role of potassium in cardiac electrophysiology. This concern is amplified by the extraordinarily high rate of sudden death among patients on maintenance hemodialysis. In this paper, we review the safety of low-potassium dialysis and make recommendations for managing patients whose serum potassium concentration falls outside the target range.

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The Influence of Hemodialysis on P‐Wave Signal‐Averaged Electrocardiogram Findings

Cited by 7 publications

References 18 publications

Electrocardiographic Changes in Patients Undergoing Hemodialysis

Electrocardiographic Changes in Patients Undergoing Hemodialysis

Anticoagulants in Patients with Atrial Fibrillation and End-Stage Renal Disease

The Safety of Low‐Potassium Dialysis

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