title: Novel Bloodless Potassium Determination Using a Signal-Processed Single-Lead ECG.
abstract: BACKGROUND
  Hyper- and hypokalemia are clinically silent, common in patients with renal or cardiac disease, and are life threatening. A noninvasive, unobtrusive, blood-free method for tracking potassium would be an important clinical advance.
  
  
  RESULTS
  Two groups of hemodialysis patients (development group, n=26; validation group, n=19) underwent high-resolution digital ECG recordings and had 2 to 3 blood tests during dialysis. Using advanced signal processing, we developed a personalized regression model for each patient to noninvasively calculate potassium values during the second and third dialysis sessions using only the processed single-channel ECG. In addition, by analyzing the entire development group's first-visit data, we created a global model for all patients that was validated against subsequent sessions in the development group and in a separate validation group. This global model sought to predict potassium, based on the T wave characteristics, with no blood tests required. For the personalized model, we successfully calculated potassium values with an absolute error of 0.36±0.34 mmol/L (or 10% of the measured blood potassium). For the global model, potassium prediction was also accurate, with an absolute error of 0.44±0.47 mmol/L for the training group (or 11% of the measured blood potassium) and 0.5±0.42 for the validation set (or 12% of the measured blood potassium).
  
  
  CONCLUSIONS
  The signal-processed ECG derived from a single lead can be used to calculate potassium values with clinically meaningful resolution using a strategy that requires no blood tests. This enables a cost-effective, noninvasive, unobtrusive strategy for potassium assessment that can be used during remote monitoring.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (Z.I.A., C.V.D.S., V.K.S., J.L.D., C.J.B., M.J.A., S.J.A., J.B., P.A.F.) Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel (Z.I.A., Y.S., D.S., A.B.G.).
authors.forename: Zachi I
authors.initials: ZI
authors.lastname: Attia
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (Z.I.A., C.V.D.S., V.K.S., J.L.D., C.J.B., M.J.A., S.J.A., J.B., P.A.F.).
authors.forename: Christopher V
authors.initials: CV
authors.lastname: DeSimone
authors.affiliation: Nephrology and Hypertension, Mayo Clinic, Rochester, MN (J.J.D.).
authors.forename: John J
authors.initials: JJ
authors.lastname: Dillon
authors.affiliation: Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel (Z.I.A., Y.S., D.S., A.B.G.).
authors.forename: Yehu
authors.initials: Y
authors.lastname: Sapir
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (Z.I.A., C.V.D.S., V.K.S., J.L.D., C.J.B., M.J.A., S.J.A., J.B., P.A.F.).
authors.forename: Virend K
authors.initials: VK
authors.lastname: Somers
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (Z.I.A., C.V.D.S., V.K.S., J.L.D., C.J.B., M.J.A., S.J.A., J.B., P.A.F.).
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dugan
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (Z.I.A., C.V.D.S., V.K.S., J.L.D., C.J.B., M.J.A., S.J.A., J.B., P.A.F.).
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Bruce
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (Z.I.A., C.V.D.S., V.K.S., J.L.D., C.J.B., M.J.A., S.J.A., J.B., P.A.F.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ackerman
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (Z.I.A., C.V.D.S., V.K.S., J.L.D., C.J.B., M.J.A., S.J.A., J.B., P.A.F.).
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.affiliation: Center for Advanced Imaging, Mayo Clinic, Rochester, MN (B.L.S.).
authors.forename: Bryan L
authors.initials: BL
authors.lastname: Striemer
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (Z.I.A., C.V.D.S., V.K.S., J.L.D., C.J.B., M.J.A., S.J.A., J.B., P.A.F.).
authors.forename: Jan
authors.initials: J
authors.lastname: Bukartyk
authors.affiliation: Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN (C.G.S.).
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Scott
authors.affiliation: Department of Engineering, Mayo Clinic, Rochester, MN (K.E.B.).
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Bennet
authors.affiliation: Mayo Clinic Ventures, Mayo Clinic, Rochester, MN (D.J.L., E.J.G.).
authors.forename: Dorothy J
authors.initials: DJ
authors.lastname: Ladewig
authors.affiliation: Mayo Clinic Ventures, Mayo Clinic, Rochester, MN (D.J.L., E.J.G.).
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Gilles
authors.affiliation: Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel (Z.I.A., Y.S., D.S., A.B.G.).
authors.forename: Dan
authors.initials: D
authors.lastname: Sadot
authors.affiliation: Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel (Z.I.A., Y.S., D.S., A.B.G.).
authors.forename: Amir B
authors.initials: AB
authors.lastname: Geva
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (Z.I.A., C.V.D.S., V.K.S., J.L.D., C.J.B., M.J.A., S.J.A., J.B., P.A.F.).
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000378:metabolism; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D007008:Hypokalemia / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood / Q000378:metabolism*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D006435:Renal Dialysis / Q000009:adverse effects; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors
chemical_list: D015415:Biomarkers; D011188:Potassium
keywords: electrophysiology; potassium; waves
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