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Hemodialysis-induced repolarization abnormalities on ECG are influenced by serum calcium levels and ultrafiltration volumes

  • Nephrology - Original Paper
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Abstract

Purpose

Hemodialysis (HD) patients are known to have high cardiovascular mortality rate. Sudden cardiac death (SCD) due to arrhythmias causes most of the cardiac deaths. HD per se may lead to ECG abnormalities and ventricular arrhythmias. Monitoring ECG parameters such as corrected QT interval, QT dispersion (QTd), Tpe interval may be useful to stratify the patients with high risk of arrhythmia and SCD. Herein we aimed to investigate the effects of changes in serum electrolyte levels and pH on ECG parameters before and after the HD.

Methods

A total of 50 chronic HD patients (mean age 58 ± 19; male 27) were enrolled. Patients with unmeasurable T waves; atrial fibrillation; bundle branch block; use of class I or class III antiarrhythmic drugs were excluded. Serum potassium, magnesium, calcium, urea, creatinine and pH were measured before and after HD treatment. Standard surface 12-lead ECGs were recorded before and after HD. QTc, QTd, Tpe, JT interval, P-wave-duration, P-wave dispersion were determined.

Results

Serum potassium and magnesium decreased, and calcium, pH and bicarbonate levels increased; QRS and Tpe interval were increased after HD. Basal Tpe was correlated with urea (r = 0.31, p = 0.02). Tpe interval was higher in hypocalcemic compared to normocalcemic patients (77 ± 11 vs 70 ± 9 ms, p = 0.02). ∆Tpe was correlated with ∆calcium (r = −0.32, p = 0.02). Basal QTc was correlated with calcium (r = −0.62, p < 0.001). ∆QTc was correlated with basal calcium (r = 0.39, p = 0.005) and ∆calcium (r = −0.46, p < 0.001). Basal JT was correlated with calcium (r = −0.55, p < 0.001). ∆JT was correlated with pH (r = 0.35, p = 0.01), ∆calcium (r = −0.53, p < 0.001) and ∆magnesium (r = −0.30, p = 0.03). Before HD, 12 patients (12%) were hypermagnesemic of whom JT intervals were lower (314 ± 20 vs 332 ± 23 ms, p = 0.02). Ultrafiltration per body weight was associated with ∆QTc (r = −0.40, p = 0.007) and ∆JT (r = −0.36, p = 0.01).

Conclusion

QRS and Tpe intervals were increased after HD. Tpe interval was longer in hypocalcemic patients. Change in Tpe was negatively associated with the change in calcium. Ultrafiltration was associated with ∆QTc and ∆JT. Calcium and ultrafiltration seem to be the most important determinants of ECG parameters of HD-induced repolarization abnormalities.

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Acknowledgements

We appreciate and thank our hemodialysis staff especially Gulden Bosgelmez, Ayse Ersoy Aydin and Semra Canpolat for their great efforts and contributions to this study.

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Authors and Affiliations

  1. Department of Internal Medicine and Nephrology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey

    Hande Ozportakal, Abdullah Ozkok, Ozlem Alkan, Ahmet Sait Bulut, Memduha Boyraz & Ali Riza Odabas

  2. Department of Cardiology, Kartal Kosuyolu High Speciality Education and Research Hospital, Istanbul, Turkey

    Mehmet Inanir & Goksel Acar

Authors
  1. Hande Ozportakal
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  2. Abdullah Ozkok
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  3. Ozlem Alkan
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  4. Ahmet Sait Bulut
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  6. Mehmet Inanir
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  7. Goksel Acar
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  8. Ali Riza Odabas
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Correspondence to Abdullah Ozkok.

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Conflict of interest

Authors HO, AO, OA, ASB, MB, MI, GA, ARO declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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

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Ozportakal, H., Ozkok, A., Alkan, O. et al. Hemodialysis-induced repolarization abnormalities on ECG are influenced by serum calcium levels and ultrafiltration volumes. Int Urol Nephrol 49, 509–515 (2017). https://doi.org/10.1007/s11255-016-1472-z

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  • DOI: https://doi.org/10.1007/s11255-016-1472-z

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