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Association Between Disturbed Serum Phosphorus Levels and QT Interval Prolongation

Sho Sasaki1,2, Kiichiro Fujisaki3, Masato Nishimura4

  • 1Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan.

Kidney International Reports
|June 20, 2024
PubMed

Insights

Low serum calcium and abnormal serum phosphorus levels are linked to QT interval prolongation in hemodialysis patients. This finding is crucial for managing cardiovascular risks in this population.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Chemistry

Background:

  • QT interval prolongation is a significant risk factor for fatal arrhythmias and cardiovascular complications.
  • The etiology of QT interval prolongation in patients undergoing hemodialysis (HD) remains poorly understood, with hypocalcemia being a suspected but unverified cause.
  • The relationship between serum phosphorus levels and QT interval prolongation in HD patients is unknown.

Purpose of the Study:

  • To determine the prevalence of QT interval prolongation in patients on maintenance hemodialysis.
  • To investigate the association between predialysis serum calcium (Ca) and phosphate (P) levels and QT interval prolongation.

Main Methods:

  • A cross-sectional study analyzed data from 204,530 adult patients on maintenance HD from the Japanese Society for Dialysis Therapy and Renal Data Registry 2019.
  • Linear regression analysis was employed to assess the relationship between predialysis serum Ca and P levels (exposures) and the rate-corrected QT (QTc) interval (outcome).
  • Multivariable analysis and restricted cubic spline curves were used to evaluate these associations.

Main Results:

  • The mean QTc interval was 451.2 ms (SD, 36.9 ms).
  • A 1 mg/dl increase in serum Ca was associated with a decrease in QTc by -2.02 ms (95% CI: -3.00 to -1.04).
  • A 1 mg/dl increase in serum P was associated with an increase in QTc by 5.50 ms (95% CI: 3.92-7.09), showing a U-shaped correlation with lower serum Ca and both decreased and increased serum P levels linked to prolonged QTc.

Conclusions:

  • Decreased serum calcium levels are associated with QT interval prolongation in patients on maintenance HD.
  • Both decreased and increased serum phosphorus levels may be associated with QT interval prolongation in this patient group.
  • These findings highlight the importance of monitoring and managing serum Ca and P levels to mitigate cardiovascular risks in HD patients.
Abstract

Keywords:
QT interval prolongationcalciumhemodialysisphosphate

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