title: Usefulness of an Upright T-Wave in Lead aVR for Predicting the Short-Term Prognosis of Incident Hemodialysis Patients: A Potential Tool for Screening High-Risk Hemodialysis Patients.
abstract: OBJECTIVE
  An upright T-wave in lead aVR (aVRT) has recently been reported to be associated with cardiovascular death and mortality among the general population and patients with prior cardiovascular disease (CVD). However, evidence for the predictive ability of aVRT in patients with chronic kidney disease is lacking. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of an upright aVRT for the short-term prognosis in incident hemodialysis patients.
  
  
  METHODS
  Among 208 patients who started maintenance hemodialysis, 79 with preexisting CVD (CVD cohort) and 129 with no history of CVD (non-CVD cohort), were studied. An upright and non-upright aVRT were defined as a wave with a positive deflection in amplitude of ≥0 mV and a negative deflection in amplitude of <0 mV, respectively. The endpoint was all-cause death.
  
  
  RESULTS
  Overall, the prevalence of an upright aVRT was 22.6% at baseline. During the mean follow-up period of 2.1 ± 1.0 years, 33 deaths occurred. Cumulative survival rates at 3 years after starting dialysis in patients with an upright and non-upright aVRT were 50.0 and 80.7%, respectively, in the CVD cohort and 92.0 and 91.3%, respectively, in the non-CVD cohort. In the CVD cohort, multivariate Cox regression analysis showed that an upright aVRT was an independent predictor of death after adjusting for confounding variables.
  
  
  CONCLUSIONS
  Among Japanese hemodialysis patients at high risk for CVD, an upright aVRT seems to be useful for predicting death.
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Matsukane
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Kubo
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Takasuke
authors.initials: T
authors.lastname: Asakawa
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Division of Dialysis, Nissan Tamagawa Hospital, Tokyo, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Imamura
authors.affiliation: Hirahata Clinic, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirahata
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Joki
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hase
keywords: Cardiovascular disease; End-stage kidney disease; Hemodialysis; Lead aVR; Mortality; T-wave