Monitoring of Serum Potassium and Calcium Levels in End-Stage Renal Disease Patients by ECG Depolarization Morphology
Hassaan A Bukhari1,2,3,4, Carlos Sánchez1,2, José Esteban Ruiz5
1BSICoS Group, I3A Institute, IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain.
Insights
New electrocardiogram (ECG) markers derived from QRS complex morphology can non-invasively estimate serum potassium and calcium levels in patients with renal disease, aiding in arrhythmia risk prediction.
Area of Science:
- Cardiology
- Biomedical Engineering
- Nephrology
Background:
- Non-invasive monitoring of serum electrolytes (potassium [K+] and calcium [Ca2+]) is crucial for preventing arrhythmias in renal disease patients.
- Current estimation methods have limitations, necessitating novel approaches.
Purpose of the Study:
- To develop novel electrocardiogram (ECG) markers based on QRS complex morphology for non-invasive estimation of serum [K+] and [Ca2+].
- To assess the performance and heart rate sensitivity of these new markers.
Main Methods:
- ECG recordings from 29 hemodialysis patients were analyzed.
- QRS morphology markers were computed using warping techniques and correlated with blood sample electrolyte levels.
- Linear regression and leave-one-out cross-validation were employed to assess estimation accuracy.
Main Results:
- QRS morphology markers strongly correlated with serum [K+] (r=0.81-0.87) and [Ca2+] (r=0.61-0.76), excluding QRS width.
- Markers demonstrated minimal sensitivity to heart rate.
- Multivariable models combining QRS and T wave markers achieved low relative errors for electrolyte estimation (<0.018 for [K+], <0.004 for [Ca2+]).
Conclusions:
- QRS morphological markers enable accurate, non-invasive estimation of serum [K+] and [Ca2+] with low heart rate dependency.
- Integrating T wave markers into multivariable models further enhances estimation performance.
- These ECG-based markers hold potential for monitoring electrolyte levels and predicting arrhythmia risk in renal disease patients.
Objective:
Non-invasive estimation of serum potassium, [K+], and calcium, [Ca2+], can help to prevent life-threatening ventricular arrhythmias in patients with advanced renal disease, but current methods for estimation of electrolyte levels have limitations. We aimed to develop new markers based on the morphology of the QRS complex of the electrocardiogram (ECG).
Methods:
ECG recordings from 29 patients undergoing hemodialysis (HD) were processed. Mean warped QRS complexes were computed in two-minute windows at the start of an HD session, at the end of each HD hour and 48 h after it. We quantified QRS width, amplitude and the proposed QRS morphology-based markers that were computed by warping techniques. Reference [K+] and [Ca2+] were determined from blood samples acquired at the time points where the markers were estimated. Linear regression models were used to estimate electrolyte levels from the QRS markers individually and in combination with T wave morphology markers. Leave-one-out cross-validation was used to assess the performance of the estimators.
Results:
All markers, except for QRS width, strongly correlated with [K+] (median Pearson correlation coefficients, r, ranging from 0.81 to 0.87) and with [Ca2+] (r ranging from 0.61 to 0.76). QRS morphology markers showed very low sensitivity to heart rate (HR). Actual and estimated serum electrolyte levels differed, on average, by less than 0.035 mM (relative error of 0.018) for [K+] and 0.010 mM (relative error of 0.004) for [Ca2+] when patient-specific multivariable estimators combining QRS and T wave markers were used.
Conclusion:
QRS morphological markers allow non-invasive estimation of [K+] and [Ca2+] with low sensitivity to HR. The estimation performance is improved when multivariable models, including T wave markers, are considered.
Significance:
Markers based on the QRS complex of the ECG could contribute to non-invasive monitoring of serum electrolyte levels and arrhythmia risk prediction in patients with renal disease.
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