title: Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis.
abstract: Sudden cardiac death is one of the primary causes of mortality in chronic hemodialysis (HD) patients. Prolonged QTc interval is associated with increased rate of sudden cardiac death. The aim of this article is to assess the abnormalities found in electrocardiograms (ECGs), and to explore factors that can influence the QTc interval.
  
  
  
  A total of 141 conventional HD patients were enrolled in this study. ECG tests were conducted on each patient before a single dialysis session and 15 minutes before the end of dialysis session (at peak stress). Echocardiography tests were conducted before dialysis session began. Blood samples were drawn by phlebotomy immediately before and after the dialysis session.
  
  
  
  Before dialysis, 93.62% of the patients were in sinus rhythm, and approximately 65% of the patients showed a prolonged QTc interval (i.e., a QTc interval above 440 ms in males and above 460ms in females). A comparison of ECG parameters before dialysis and at peak stress showed increases in heart rate (77.45±11.92 vs. 80.38±14.65 bpm, p = 0.001) and QTc interval (460.05±24.53 ms vs. 470.93±24.92 ms, p<0.001). After dividing patients into two groups according to the QTc interval, lower pre-dialysis serum concentrations of potassium (K+), calcium (Ca2+), phosphorus, calcium* phosphorus (Ca*P), and higher concentrations of plasma brain natriuretic peptide (BNP) were found in the group with prolonged QTc intervals. Patients in this group also had a larger left atrial diameter (LAD) and a thicker interventricular septum, and they tended to be older than patients in the other group. Then patients were divided into two groups according to ΔQTc (ΔQTc = QTc peak-stress- QTc pre-HD). When analyzing the patients whose QTc intervals were longer at peak stress than before HD, we found that they had higher concentrations of Ca2+ and P5+ and lower concentrations of K+, ferritin, UA, and BNP. They were also more likely to be female. In addition, more cardiac construction abnormalities were found in this group. In multiple regression analyses, serum Ca2+ concentration before HD and LAD were independent variables of QTc interval prolongation. UA, ferritin, and interventricular septum were independent variables of ΔQTc.
  
  
  
  Prolonged QT interval is very common in HD patients and is associated with several risk factors. An appropriate concentration of dialysate electrolytes should be chosen depending on patients' clinical conditions.
authors.affiliation: Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China.
authors.forename: Yuxin
authors.initials: Y
authors.lastname: Nie
authors.affiliation: Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China.|Key Laboratory of Kidney and Blood Purification of Shanghai, Shanghai, P. R. China.
authors.forename: Jianzhou
authors.initials: J
authors.lastname: Zou
authors.affiliation: Division of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.
authors.forename: Yixiu
authors.initials: Y
authors.lastname: Liang
authors.affiliation: Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.affiliation: Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China.
authors.forename: Zhonghua
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China.
authors.forename: Xuesen
authors.initials: X
authors.lastname: Cao
authors.affiliation: Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China.|Shanghai Institute of Kidney Disease and Dialysis, Shanghai, P. R. China.|Key Laboratory of Kidney and Blood Purification of Shanghai, Shanghai, P. R. China.
authors.forename: Xiaoqiang
authors.initials: X
authors.lastname: Ding
mesh_terms: D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013997:Time Factors