Prognostic value of chronic ECG changes in patients undergoing hemodialysis

Patients on maintenance hemodialysis (HD) face high cardiovascular (CV) mortality risk. Although electrocardiograms (ECGs) are routinely performed, the prognostic significance of chronic ECG abnormalities in predicting mortality among HD patients remains unclear.

We retrospectively analyzed patients with kidney failure receiving maintenance HD at a single center between January 2000 and March 2022. ECGs obtained within two years of the end of follow-up were independently reviewed by two physicians. Multivariable logistic regression was used to identify predictors of mortality, integrating clinical and ECG parameters. Model performance was assessed using calibration and discrimination statistics.

Of 291 records, 149 were included (mean age 67.1 ± 13.2 years; 64.4% male; median dialysis vintage 47 months [IQR 25-87]). Common comorbidities included hypertension (90%), diabetes (54.4%), and coronary artery disease (42.4%). Frequent ECG findings were ST depression (33.8%), left axis deviation (32.9%), and poor R-wave progression (26.4%), with sinus rhythm in 94%. Overall mortality was 55%, including31.7% sudden cardiac deaths. The final model showed good calibration and excellent discrimination (AUC 0.80 ± 0.04, P < 0.001).

ECG abnormalities enhance mortality risk prediction in HD patients and should be validated in larger prospective cohorts.