title: Nocturnal home hemodialysis associates with improvement of electrocardiographic features linked to sudden cardiac death.
abstract: Sudden cardiac death (SCD) remains the leading cause of death in hemodialysis patients. We performed a retrospective electrocardiograph (ECG) and chart review to determine whether hemodialysis modality, frequency, or duration could predict change in ECG parameters associated with SCD. Frequent nocturnal hemodialysis was associated with an improvement in Tpeak to Tend within 365 days (83.8-71.8 ms, p = 0.005) and past 365 days of dialysis initiation (85.9-77.1 ms, p = 0.005) and improvement in QRS amplitude variation within 365 days (0.0583-0.0297, p = 0.025) and past 365 days of dialysis initiation (0.0546-0.0332, p = 0.029). Compared with intermittent conventional hemodialysis, more frequent nocturnal (15/25 vs. 3/14, p = 0.04) and intermittent nocturnal hemodialysis (INHD) (6/8 vs. 3/14, p = 0.03) patients decreased Tpeak to Tend. More short-hours daily than INHD patients increased T-wave amplitude variation (16/25 vs. 1/8, p = 0.02). These improvements occurred before changes in Cornell or Sokolow-Lyon electrocardiographic left ventricular mass. Thus, it appears that hemodialysis modalities of longer duration are associated with improvements in electrocardiographic parameters associated with SCD. Prospective trials are required to determine whether dialysis prescription reduces SCD, cardiovascular morbidity, and mortality in hemodialysis patients.
authors: From the *London Health Sciences Centre and Western University, London, Ontario, Canada; †Department of Medical Biophysics, Western University, London, Ontario, Canada; ‡Division of Nephrology, Department of Medicine, The Toronto General Hospital, University Health Network, Ontario, Canada; and §Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.
authors: Benjamin K A
authors: BK
authors: Thomson
authors: Shi-Han S
authors: SH
authors: Huang
authors: Christopher
authors: C
authors: Chan
authors: Bradley
authors: B
authors: Urquhart
authors: Allan
authors: A
authors: Skanes
authors: Robert M
authors: RM
authors: Lindsay
mesh_terms: D000328:Adult; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D006437:Hemodialysis, Home / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies