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Prolongation of QTc interval at the beginning and during dialysis is associated with hypervolemia and calcium and magnesium change in the first 2 h

  • Nephrology - Original Paper
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Abstract

Background and aims

High rates of sudden cardiac death are mostly attributed to ventricular arrhythmias including QTc prolongation in hemodialysis patients. We aimed to investigate the correlation of electrolyte and volume changes with QTc interval prolongation in hemodialysis patients.

Study design

The present study is designed as a cross-sectional study.

Methods

The study was conducted at the hemodialysis unit of a training and research hospital and its’ satellite dialysis unit. Patients were divided into three groups. Group-1: with normal QTc interval both at the beginning and during dialysis session; group-2: with prolonged QTc interval at the beginning and remained prolonged during dialysis session; group-3: with normal QTc interval at the beginning but prolonged during the dialysis session. In addition, patients were evaluated in terms of QTc change between the beginning and 2nd hour (delta-QTc-1) and between 2nd hour and 4th hour (delta-QTc-2), respectively, and defined as ‘patients with increased QTc interval’ and ‘patients without increased QTc interval’.

Results

A total of 45 prevalent hemodialysis patients were enrolled in the study. 14 patients (31.1%) had normal QTc interval (group-1), 13 patients (28.9%) had prolonged QTc interval at the beginning and remained prolonged during dialysis session (group-2) and 18 patients (40%) had normal QTc interval at the beginning but prolonged during dialysis session (group-3). There was no statistically significant difference between groups in terms of baseline electrolyte levels. Calcium change in the first 2 h was lower in patients with QTc prolongation from the start or during the dialysis session (group-2 and group-3). In addition, systolic blood pressure (SBP) levels at the beginning of the session (118 ± 15 mmHg vs 124 ± 28 mmHg vs138 ± 24 mmHg; p = 0.04) and intradialytic ultrafiltration (UF) rate were higher (1.96 ± 0.6 L/4 h vs 2.6 ± 1.0 L/4 h vs 2.8 ± 0.9 L/4 h; p = 0.03) in group-2 and group-3 compared to patients in group-1. Increase in QTc interval was found higher in patients with less calcium increase (Rho: − 0.36; p = 0.01) and with greater magnesium decrease in the first 2 h (Rho: 0.31; p = 0.04).

Conclusion

QTc interval prolongation is common among hemodialysis patients. High intradialytic UF rates, change in serum magnesium and calcium levels in the first 2 h were found associated with QTc prolongation. However, QTc prolongation was found independently associated only with UF volume and calcium change in the first 2 h.

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Nephrology, University of Health Sciences Bozyaka Training and Research Hospital, Saim Cikrikci Street, No:59Karabaglar, 35360, Izmir, Turkey

    I. Bozaci & E. Tatar

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  1. I. Bozaci
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  2. E. Tatar
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Correspondence to I. Bozaci.

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The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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All the procedures were implemented after the approval of the University of Health Sciences Izmir Bozyaka Training and Research Hospital Ethics Committee. This study was carried out in accordance with the Helsinki Declaration standards.

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Informed consent was obtained from all participants included in the study.

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Bozaci, I., Tatar, E. Prolongation of QTc interval at the beginning and during dialysis is associated with hypervolemia and calcium and magnesium change in the first 2 h. Int Urol Nephrol 54, 1399–1408 (2022). https://doi.org/10.1007/s11255-021-03016-0

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  • DOI: https://doi.org/10.1007/s11255-021-03016-0

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