Correlation between iron stores and QTc dispersion in chronic ambulatory peritoneal dialysis patients

Bavbek, Nüket; Yılmaz, Hikmet; Erdemli, Hacı Kemal; Selcuki, Yusuf; Duranay, Murat; Akçay, Ali

doi:10.3109/0886022x.2013.836750

Cited by 12 publications

(7 citation statements)

References 24 publications

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“…Additionally, elevated serum ferritin levels have been observed in patients with renal impairment, and these elevated levels are closely related to a higher risk of CKD, a rapid decline in renal function and progression to renal replacement therapy (RRT) [22][23][24]. Accumulating evidence has demonstrated that hyperferritinemia is significantly associated with poor prognosis, including higher mortality in MHD and PD patients [6,[25][26][27], although the threshold values at which serum ferritin contributes to negative outcomes differ between MHD and PD patients; these ferritin levels are higher than the demand for erythropoiesis.…”

Section: Discussionmentioning

confidence: 99%

Systemic inflammation modulates the ability of serum ferritin to predict all-cause and cardiovascular mortality in peritoneal dialysis patients

Chen

Liu

et al. 2020

BMC Nephrol

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Background This study aimed to ascertain whether the correlation of high serum ferritin with mortality is affected by systemic inflammation and to investigate the optimal serum ferritin level for predicting death when inflammation is considered in peritoneal dialysis (PD) patients. Methods We classified 221 patients into four groups according to serum ferritin concentration (100 μg/L) and high-sensitivity CRP (hs-CRP) level (3 mg/L), and followed them regularly from the date of catheterization to Dec 31, 2016, at Sun Yat-Sen Memorial Hospital, China. Clinical and biochemical data were collected at baseline, and clinical outcomes such as all-cause and cardiovascular mortality were assessed. Results During a median follow-up of 35 months (3 ~ 109 months), 50 (22.6%) deaths occurred. Cardiovascular disease (46.0%) was the most common cause of death, followed by infection (10.0%). The Kaplan–Meier survival analysis and log-rank test revealed significantly worse survival accumulation among PD patients with higher serum ferritin (≥100 μg/L) under elevated hsCRP levels (> 3 mg/L) (P = 0.022). A multivariate Cox regression analysis revealed that an increased serum ferritin level was independently associated with a higher risk of all-cause and cardiovascular mortality in PD patients (HR = 3.114, P = 0.021; and HR = 9.382, P = 0.032) with hsCRP above 3 mg/L after adjusting for relevant confounding factors. Conclusion Higher serum ferritin levels were associated with an increased risk of all-cause and cardiovascular mortality in patients undergoing PD only in the presence of elevated hsCRP levels. The correlation of serum ferritin with poor outcome should take into consideration systemic inflammation.

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Section: Discussionmentioning

confidence: 99%

Systemic inflammation modulates the ability of serum ferritin to predict all-cause and cardiovascular mortality in peritoneal dialysis patients

Chen

Liu

et al. 2020

BMC Nephrol

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“…[16] It was also observed in study of Bavbek et al, who examined peritoneal dialysis patients, that increased iron stores were associated with prolonged QTd. [17] Patients with prolonged QTd have higher levels of iron and transferrin saturation. Numerous studies have revealed the fact that iron overload plays a role in the pathogenesis of atherosclerosis and is associated with deaths related to coronary artery diseases.…”

Section: Discussionmentioning

confidence: 99%

The association between corrected QT dispersion and iron parameters in hemodialysis diseases

Erdoğan

Erdogan

Şavlı

2017

EJMO

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Objectives: Anemia is one of the most common complications to occur in hemodialysis patients. Blood transfusions to correct anemia can result in iron accumulation in the parenchymal tissues. Iron accumulation in the heart leads to fibrosis in the myocardium. The aim of this study was to determine the association between corrected QT dispersion (QTcd) and serum iron parameters in patients with end-stage renal disease. Methods: A total of 80 subjects (60 patients and 20 healthy) were enrolled in the study. Patients were receiving hemodialysis treatment 3 times a week with regular erythropoietin and iron replacement at least once a year. Patients with cardiac insufficiency; diabetes mellitus; ischemic heart disease diagnosed with effort test or coronary angiography; any acute infectious disease; branch block on electrocardiogram (ECG); arrhythmia, such as atrial fibrillation, bradycardia, or tachycardia; patients using any drug that affects QT interval; and patients with electrolyte disturbances were excluded. Blood sample was taken and ECG recordings were made 1 day after routine hemodialysis to ensure that the patient's laboratory tests and ECG parameters were not affected by acute metabolic effects of dialysis. Patients whose corrected QT (QTc) interval was calculated in at least 9 derivations were included in the study. QTcd was measured by calculating the difference between the longest QTc interval and the shortest QTc interval. Results: The hematocrit and hemoglobin levels of patients were statistically lower than those of the control group (p<0.05 for both). Serum iron level and percent transferrin saturation index were similar between groups. Ferritin level of the patients was statistically higher than the ferritin level of the control group (p<0.01). On the other hand, the total iron binding capacity level of the patient group was statistically significantly lower compared with the total iron binding capacity level of the control group (p<0.01). The longest QT interval of the patients was statistically significantly longer compared with the control group (p<0.01). There was no statistically significant difference between the 2 groups with normal and longer corrected QT dispersion (QTcd) in terms of dialysis duration or age (p>0.05). QTcd was not significantly correlated with age, duration of dialysis, calcium, potassium, iron, or ferritin level (p>0.05 for all). A statistically significant correlation was only found between QTcd and transferrin saturation index (r=0.254; p<0.05). Conclusion:The hemodialysis patients had a longer QTcd compared with individuals with normal renal function in our study. A positive correlation was detected between the transferrin saturation index and QTcd. Iron replacement therapy should be administered more carefully and reduced iron concentration and transferrin saturation index should be targeted in hemodialysis patients with QTcd longer than 50 milliseconds.

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“…Jos perteklius HD pacientams sukelia oksidacinį stresą ir gali pagreitinti aritmijų atsiradimą. Didelės geležies atsargos PD pacientams yra susijusios su didesne QT dispersija [38].…”

Section: Elektrokardiografiniai Pokyčiaiunclassified

Damoklo kardas: širdies įvykiai dializės metu

Januškevičius

Grigutis

Rimševičius

et al. 2015

Medicinos Teorija Ir Praktika

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santraukaReikšminiai žodžiai: hemodializė, aritmija, prieširdžių virpėjimas, staigi kardialinė mirtis. Lėtinė inkstų liga, kai reikalinga pakaitinė inkstų terapija, -svarbi visuomenės sveikatos problema. Kiekvienos hemodializės (HD) metu atsiranda didelė apkrova širdies ir kraujagyslių sistemai, susijusi su skysčių ir elektrolitų pokyčiais. Šiame straipsnyje apžvelgiami dažniausiai pasitaikantys širdies ir kraujagyslių sistemos pokyčiai HD pacientams. Prieširdžių virpėjimas (PV) -viena dažniausių aritmijų klinikinėje praktikoje. Hipokalemija -svarbus rizikos veiksnys, susijęs su prieširdžių virpė-jimo atsiradimu. Staigi kardialinė mirtis -tai netikėta žmogaus mirtis dėl širdies priežasčių, atsirandančių per trumpą laiką, kuriam anksčiau buvo arba nebuvo nustatyta širdies patologija, o akivaizdi terminalinė būklė anksčiau nebuvo diagnozuota. HD metu dažnai pastebimi pokyčiai elektrokardiogramoje. QT intervalas (norma 0,24-0,45 s) yra žinomas kaip skilvelinės repoliarizacijos žymuo, o jo pailgėjimas susijęs su padidėjusia aritmijų rizika. Hipokalemijai būdinga T bangos pailgėjimas, ST segmento depresija, patologinis U dantelis, supraventrikulinės ir skilvelinės tachikardijos bei aritmijos. Šiuos rizikos veiksnius ir širdies sutrikimus būtina laiku nustatyti ir koreguoti, todėl svarbus pastovus širdies parametrų (širdies dažnio variabilumo, elektrokardiogramos) fiksavimas hemodializės metu. aBstract Key words: hemodialysis, arrhythmia, atrial fibrillation, sudden cardiac death. Chronic kidney disease requiring renal replacement therapy is an important social problem. A large strain appears for the heart and cardiovascular system during each hemodialysis (HD) session. It is associated with changes of fluids and electrolytes. Most common cardiovascular system abnormalities during hemodialysis are reviewed in this article. Atrial fibrillation is one of the most frequent arrhythmia in clinical practice. Hypokalemia is an important risk factor related to the developing of atrial fibrillation. Sudden cardiac death is unexpected death due to heart causes, which appears in a short time, when no cardiac pathology was identified earlier and no fatal condition was diagnosed. QT interval (0,24-0,45 s) is known as a ventricular repolarisation marker and its elongation is associated with increased risk of arrhythmias. T wave elongation, ST segment depression, pathological U peak, supraventricular, ventricular tachycardia, arrhythmias are specific to hypokalemia. These risk factor and cardiac events must be diagnosed and treated. This condition requires intradialytic monitoring of cardiac parameters, such as heart rate variability and ECG. ĮVADASInkstų ligos, kai reikalinga pakaitinė inkstų terapija, -svarbi visuomenės sveikatos problema. Standartinė hemodializė (HD) dažniausiai atliekama tris kartus per savaitę -kiekvieno gydymo metu atkuriamas skysčių ir elektrolitų disbalansas. Nepaisant tobulėjančių technologijų dializės srityje, tik vienas iš dviejų ligonių išgyvena trejus metus po dializės pradžios. Kasmetis mirtingumas yra...

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Correlation between iron stores and QTc dispersion in chronic ambulatory peritoneal dialysis patients

Cited by 12 publications

References 24 publications

Systemic inflammation modulates the ability of serum ferritin to predict all-cause and cardiovascular mortality in peritoneal dialysis patients

Systemic inflammation modulates the ability of serum ferritin to predict all-cause and cardiovascular mortality in peritoneal dialysis patients

The association between corrected QT dispersion and iron parameters in hemodialysis diseases

Damoklo kardas: širdies įvykiai dializės metu

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