title: Hemodiafiltration and hemodialysis differently affect P wave duration and dispersion on the surface electrocardiogram.
abstract: OBJECTIVE
  The incidence of atrial fibrillation is increased during hemodialysis (HD); however, the effects of hemodiafiltration (HDF) on atrial arrhythmias have not been evaluated. The prolongation of the P wave and P dispersion (Pd) can predict atrial arrhythmias.
  
  
  METHODS
  Data from 30 patients receiving HDF over a period of 3 months were collected; the same group of patients was then evaluated during treatment with conventional HD for at least another 3 months. Electrolyte values were obtained, and surface electrocardiograms (ECG), echocardiography, and Holter ECGs were performed.
  
  
  RESULTS
  The duration of the P wave and Pd increased significantly during HD. The left atrial diameter decreased significantly only during HDF. During HDF, the left atrial cross diameter measured at the beginning of the session was positively correlated with the incidence of supraventricular premature beats (p = 0.011, r = 0.4556). The decrease in left atrial diameter during HDF was negatively correlated with the incidence of supraventricular premature beats (p = 0.016, r = -0.43). During HDF, the changes in sodium and Pd were significantly positively correlated (p < 0.05, r = 0.478). During HD, the changes in ionized calcium levels and Pd were positively correlated (p < 0.05, r = 0.377).
  
  
  CONCLUSIONS
  Our results suggest that HDF has a more beneficial effect on P wave duration and Pd than HD. The alterations in the ECG markers may be the result of the simultaneous occurrence of certain electrolyte imbalances and renal replacement methods.
authors.affiliation: Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary.
authors.forename: Alida
authors.identifier: http://orcid.org/0000-0002-7088-7108
authors.initials: A
authors.lastname: Páll
authors.affiliation: Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary.
authors.forename: Árpád
authors.initials: Á
authors.lastname: Czifra
authors.affiliation: Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary.
authors.forename: Veronika
authors.initials: V
authors.lastname: Sebestyén
authors.affiliation: Division of Nephrology, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: Gergely
authors.initials: G
authors.lastname: Becs
authors.affiliation: Faculty of Medicine, Clinical Center, Institute of Cardiology, University of Debrecen, Debrecen, Hungary.
authors.forename: Csaba
authors.initials: C
authors.lastname: Kun
authors.affiliation: Division of Nephrology, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: József
authors.initials: J
authors.lastname: Balla
authors.affiliation: Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Paragh
authors.affiliation: Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary.
authors.forename: István
authors.initials: I
authors.lastname: Lőrincz
authors.affiliation: Division of Nephrology, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: Dénes
authors.initials: D
authors.lastname: Páll
authors.affiliation: Division of Nephrology, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: Tamás János
authors.initials: TJ
authors.lastname: Padra
authors.affiliation: Department of Medicine, Nephrology Research and Training Center and Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Anupam
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Medicine, Nephrology Research and Training Center and Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Zarjou
authors.affiliation: Division of Emergency Medicine, Faculty of Medicine, Clinical Center, Institute of Medicine, University of Debrecen, Nagyerdei krt. 98, P.O. Box 19, 4032, Debrecen, Hungary. szaboz.med@gmail.com.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szabó
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017583:Hemodiafiltration / Q000009:adverse effects*; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D055815:Young Adult
keywords: Arrhythmias; Atrial fibrillation; Hemodiafiltration; Hemodialysis; P wave dispersion