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Electrocardiographic monitoring in children with chronic renal failure
A Bosch1, H E Ulmer, H E Keller
1Division of Paediatric Nephrology, University Children's Hospital, Heidelberg, Federal Republic of Germany.
Insights
Continuous electrocardiographic (ECG) monitoring in children with chronic renal failure revealed no life-threatening cardiac dysrhythmias. However, some had premature ventricular complexes and QT interval prolongation, highlighting ECG
Area of Science:
- Pediatric Nephrology
- Cardiology
- Clinical Electrophysiology
Background:
- Children with chronic renal failure (CRF) are at risk for cardiac complications.
- Previous studies on cardiac dysrhythmias in pediatric CRF are limited.
- Understanding cardiac rhythm alterations during renal replacement therapy is crucial.
Purpose of the Study:
- To determine the incidence and nature of cardiac dysrhythmias in children with CRF.
- To assess electrocardiographic (ECG) changes during hemodialysis and continuous ambulatory peritoneal dialysis (CAPD).
- To evaluate the utility of continuous ECG monitoring in this population.
Main Methods:
- 24-hour continuous electrocardiographic (ECG) monitoring in 44 children with varying stages of CRF.
- ECG monitoring during hemodialysis sessions.
- ECG monitoring during dialysate exchanges in CAPD patients.
Main Results:
- No life-threatening dysrhythmias were observed, unlike in adult hemodialysis patients.
- 41% of children exhibited premature ventricular complexes, within the upper range of healthy children.
- Transient QT interval prolongation (up to 40%) occurred in 57% of patients without significant electrolyte changes; CAPD patients showed a relatively high heart rate that varied during exchanges.
Conclusions:
- Continuous ECG monitoring is valuable for detecting cardiac rhythm and conduction alterations in pediatric CRF.
- While severe dysrhythmias are uncommon, subclinical findings like PVCs and QT prolongation warrant attention.
- Specific monitoring during dialysis procedures is recommended for pediatric CRF patients.
Abstract:
Continuous electrocardiographic (ECG) monitoring was performed over 24 h in 44 children at various stages of chronic renal failure in order to determine the incidence and nature of cardiac dysrhythmias. In addition the ECG was followed during haemodialysis sessions and during dialysate exchanges in continuous ambulatory peritoneal dialysis (CAPD) patients. In contrast to adult patients on haemodialysis life-threatening dysrhythmias were not observed. The proportion of children with premature ventricular complexes (41%) was at the upper limit of that in healthy children. A relatively high heart rate was found in children on CAPD, which varied during the exchange procedure. In 57% of all patients a transient marked prolongation of the QT interval up to 40% greater than normal was observed without obvious changes in the serum electrolyte levels. Continuous ECG monitoring is a useful tool for detecting alterations of cardiac rhythm and conduction in at-risk children with renal failure.