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Electrocardiographic substrates of arrhythmias in patients with end-stage and chronic kidney diseases: a case-control
Hesham Yehia1,2, Ghada Youssef3,4, Mona Gamil1,5
1Cairo University, Cairo, Egypt.
Insights
Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) show significant electrocardiogram (ECG) changes indicating arrhythmia risk. These changes, including increased QTc dispersion and P wave dispersion, are more pronounced in patients undergoing hemodialysis.
Area of Science:
- Nephrology
- Cardiology
- Clinical Electrophysiology
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality in renal disease patients, with higher incidence of cardiac arrhythmia and sudden cardiac death in hemodialysis patients.
- Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) are at increased risk for cardiac arrhythmias, even without clinically apparent heart disease.
Purpose of the Study:
- To compare specific electrocardiogram (ECG) changes as potential markers of arrhythmias in patients with CKD and ESRD.
- To evaluate these ECG markers in patients without clinically manifest heart disease against normal controls.
Main Methods:
- Inclusion of 75 ESRD patients on hemodialysis, 75 patients with stage 3-5 CKD, and 40 healthy controls.
- Comprehensive clinical evaluation and laboratory tests (serum creatinine, GFR, electrolytes, iron studies, PTH, TIBC).
- Resting 12-lead ECG to measure P wave dispersion (P-WD), corrected QT interval (QTc) dispersion, Tpeak-Tend interval (Tp-e), and Tp-e/QT ratio.
Main Results:
- ESRD patients exhibited significantly higher QTc dispersion and P-WD compared to CKD and control groups (p < 0.001).
- In ESRD patients, male gender was associated with higher P-WD (p=0.045).
- Multivariate analysis identified serum creatinine and transferrin saturation as predictors of QTc dispersion in ESRD, while ejection fraction, hypertension, hemoglobin, male gender, and TIBC predicted P-WD.
Conclusions:
- Patients with stage 3-5 CKD and ESRD on hemodialysis demonstrate significant ECG alterations.
- These ECG changes are considered substrates for both ventricular and supraventricular arrhythmias.
- The observed ECG abnormalities are more pronounced in patients undergoing regular hemodialysis.
Background:
Cardiovascular disease (CVD) is the most common cause of death in patients with renal diseases. Cardiac arrhythmia and sudden cardiac death are particularly important, and the burden is higher in patients on hemodialysis. The aim of this study is to compare specific ECG changes as markers of arrhythmias in patients with CKD and patients with end-stage renal disease (ESRD); all without clinically manifest heart disease, with normal control subjects.
Results:
Seventy-five ESRD patients on regular hemodialysis, 75 patients with stage 3-5 CKD and 40 healthy control subjects were included. All candidates were subjected to thorough clinical evaluation and laboratory tests including serum creatinine, glomerular filtration rate calculation, serum potassium, magnesium, calcium, phosphorus, iron, parathyroid hormone, and total iron binding capacity (TIBC). Resting twelve-lead ECG was done to calculate P wave dispersion (P-WD), corrected QT interval, QTc dispersion, Tpeak-Tend interval (Tp-e), and Tp-e/QT. Patients with ESRD had a significantly higher QTc dispersion (p < 0.001) and P-WD (p = 0.001) when compared to the other 2 groups. In the ESRD group, males had a significantly higher P-WD (p = 0.045), insignificantly higher QTc dispersion (p = 0.445), and insignificantly lower Tp-e/QT ratio (p = 0.252) as compared to females. Multivariate linear regression analysis for ESRD patients showed that serum creatinine (β = 0.279, p = 0.012) and transferrin saturation (β = - 0.333, p = 0.003) were independent predictors of increased QTc dispersion while ejection fraction (β = 0.320, p = 0.002), hypertension (β = - 0.319, p = 0.002), hemoglobin level (β = - 0.345, p = 0.001), male gender (β = - 0.274, p = 0.009) and TIBC (β = - 0.220, p = 0.030) were independent predictors of increased P wave dispersion. In the CKD group, TIBC (β = - 0.285, p = 0.013) was an independent predictor of QTc dispersion while serum calcium (β = 0.320, p = 0.002) and male gender (β = - 0.274, p = 0.009) were independent predictors of Tp-e/QT ratio.
Conclusions:
Patients with stage 3-5 CKD and those with ESRD on regular hemodialysis exhibit significant ECG changes that are considered substrates for ventricular as well as supraventricular arrhythmias. Those changes were more evident in patients on hemodialysis.
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