title: Hemodialysis-induced repolarization abnormalities on ECG are influenced by serum calcium levels and ultrafiltration volumes.
abstract: OBJECTIVE
  Hemodialysis (HD) patients are known to have high cardiovascular mortality rate. Sudden cardiac death (SCD) due to arrhythmias causes most of the cardiac deaths. HD per se may lead to ECG abnormalities and ventricular arrhythmias. Monitoring ECG parameters such as corrected QT interval, QT dispersion (QTd), Tpe interval may be useful to stratify the patients with high risk of arrhythmia and SCD. Herein we aimed to investigate the effects of changes in serum electrolyte levels and pH on ECG parameters before and after the HD.
  
  
  METHODS
  A total of 50 chronic HD patients (mean age 58 ± 19; male 27) were enrolled. Patients with unmeasurable T waves; atrial fibrillation; bundle branch block; use of class I or class III antiarrhythmic drugs were excluded. Serum potassium, magnesium, calcium, urea, creatinine and pH were measured before and after HD treatment. Standard surface 12-lead ECGs were recorded before and after HD. QTc, QTd, Tpe, JT interval, P-wave-duration, P-wave dispersion were determined.
  
  
  RESULTS
  Serum potassium and magnesium decreased, and calcium, pH and bicarbonate levels increased; QRS and Tpe interval were increased after HD. Basal Tpe was correlated with urea (r = 0.31, p = 0.02). Tpe interval was higher in hypocalcemic compared to normocalcemic patients (77 ± 11 vs 70 ± 9 ms, p = 0.02). ∆Tpe was correlated with ∆calcium (r = -0.32, p = 0.02). Basal QTc was correlated with calcium (r = -0.62, p < 0.001). ∆QTc was correlated with basal calcium (r = 0.39, p = 0.005) and ∆calcium (r = -0.46, p < 0.001). Basal JT was correlated with calcium (r = -0.55, p < 0.001). ∆JT was correlated with pH (r = 0.35, p = 0.01), ∆calcium (r = -0.53, p < 0.001) and ∆magnesium (r = -0.30, p = 0.03). Before HD, 12 patients (12%) were hypermagnesemic of whom JT intervals were lower (314 ± 20 vs 332 ± 23 ms, p = 0.02). Ultrafiltration per body weight was associated with ∆QTc (r = -0.40, p = 0.007) and ∆JT (r = -0.36, p = 0.01).
  
  
  CONCLUSIONS
  QRS and Tpe intervals were increased after HD. Tpe interval was longer in hypocalcemic patients. Change in Tpe was negatively associated with the change in calcium. Ultrafiltration was associated with ∆QTc and ∆JT. Calcium and ultrafiltration seem to be the most important determinants of ECG parameters of HD-induced repolarization abnormalities.
authors.affiliation: Department of Internal Medicine and Nephrology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey.
authors.forename: Hande
authors.initials: H
authors.lastname: Ozportakal
authors.affiliation: Department of Internal Medicine and Nephrology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey. abdullahozkok@yahoo.com.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Ozkok
authors.affiliation: Department of Internal Medicine and Nephrology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Alkan
authors.affiliation: Department of Internal Medicine and Nephrology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey.
authors.forename: Ahmet Sait
authors.initials: AS
authors.lastname: Bulut
authors.affiliation: Department of Internal Medicine and Nephrology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey.
authors.forename: Memduha
authors.initials: M
authors.lastname: Boyraz
authors.affiliation: Department of Cardiology, Kartal Kosuyolu High Speciality Education and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Inanir
authors.affiliation: Department of Cardiology, Kartal Kosuyolu High Speciality Education and Research Hospital, Istanbul, Turkey.
authors.forename: Goksel
authors.initials: G
authors.lastname: Acar
authors.affiliation: Department of Internal Medicine and Nephrology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey.
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Odabas
mesh_terms: D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000097:blood; D002118:Calcium / Q000097:blood; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D004573:Electrolytes / Q000097:blood*; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008274:Magnesium / Q000097:blood; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*; D014508:Urea / Q000097:blood
chemical_list: D001639:Bicarbonates; D004573:Electrolytes; D014508:Urea; D003404:Creatinine; D008274:Magnesium; D011188:Potassium; D002118:Calcium
keywords: Arrhythmia; Calcium; Hemodialysis; JT interval; QT interval; Tpe interval; Ultrafiltration