ECG changes and cardiac arrhythmias in chronic renal failure patients on hemodialysis

Shapira, Oz M.; Bar-Khayim, Y

doi:10.1016/0022-0736(92)90032-u

Cited by 70 publications

(67 citation statements)

References 21 publications

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“…This is also in accordance with the findings of Shapira and Bar-Khayim [10], who reported that HD patients exhibited electrocardiographic changes, which were most pronounced during the first 2 h of dialysis. In the light of our results, we believe that PWD increases during HD, especially during the first 2 h of dialysis session, but returns back to predialysis values after effective HD.…”

Section: Discussionsupporting

confidence: 82%

“…PWD remained stable during HD in one study [7], while others reported either increase [8, 9] or even decrease in PWD [10, 11]. The response of P wave duration and PWD to HD may be variable and mediated by an interplay of electrolytic shifts and electrophysiologic and extracardiac mechanisms associated with the alleviation of fluid overload [12].…”

Section: Introductionmentioning

confidence: 99%

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P Wave Dispersion Increases during Hemodialysis Sessions

Özben¹,

Toprak²,

Koç³

et al. 2009

Nephron Clin Pract

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Background/Aims: Atrial fibrillation (AF) is common among hemodialysis (HD) patients and is associated with high mortality. P wave dispersion (PWD) is a noninvasive electrocardiographic marker of paroxysmal AF. Our aim was to evaluate the effect of HD session on PWD. Methods: Twenty-five patients (mean age 63 years, 10 males) with sinus rhythm and undergoing chronic HD treatment were included. Blood samples were drawn and 12-lead electrocardiograms were recorded immediately before HD session, at the 2nd hour during HD and at the end of the HD session. The difference between maximum and minimum P wave durations was calculated as PWD. Results: PWD significantly increased during HD sessions compared with predialysis values (41 ± 12 vs. 21 ± 10 ms, respectively, p < 0.001), then decreased to a value of 24 ± 7 ms at the completion of HD, which was not significantly different from the predialysis values. PWD during HD was significantly correlated with predialysis systolic and diastolic blood pressure (r = 0.42, p = 0.037, and r = 0.59, p = 0.002, respectively) and predialysis serum potassium level (r = 0.44, p = 0.031). Linear regression model revealed that predialysis diastolic blood pressure (p = 0.002), predialysis serum potassium level (p = 0.037) and the amount of ultrafiltration (p = 0.048) were the significant predictors of prolonged PWD during HD. Conclusion: PWD increases significantly during HD sessions. This may increase the risk of AF episodes during HD. High diastolic blood pressure and serum potassium level before HD and ultrafiltration amount may predict prolonged PWD during HD.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

P Wave Dispersion Increases during Hemodialysis Sessions

Özben¹,

Toprak²,

Koç³

et al. 2009

Nephron Clin Pract

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“…The echocardiographic findings of dialysisinduced LV RWMA that were seen in both our previous study and in these results are strongly suggestive of subclinical ischemia, analogous to dobutamine stress echocardiography (16). In addition to the work from our center, one study demonstrated dialysis-induced perfusion defects using single photon emission computed tomography (7), and there are 10 reports of silent intradialytic ST depression detected by Holter monitoring (6,(17)(18)(19)(20)(21)(22)(23)(24)(25). Although initially there was concern that some electrocardiographic changes that were observed during dialysis were related to changes in electrolyte concentrations as opposed to myocardial hypoperfusion, the demonstration of dialysis-induced ischemia by electrocardiographic, echocardiographic, and isotopic techniques certainly suggests that such findings are attributable to ischemia.…”

Section: Discussionmentioning

confidence: 99%

Dialysis-Induced Regional Left Ventricular Dysfunction Is Ameliorated by Cooling the Dialysate

Selby

Burton

Chesterton

et al. 2006

Clinical Journal of the American Society of Nephrology

155

166

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Dialysis patients who develop cardiac failure have a poor prognosis. Recurrent subclinical myocardial ischemia is important in the genesis of heart failure in nondialysis patients. It has previously been demonstrated that subclinical ischemia occurs during hemodialysis; therefore, this study examined whether the improved stability of cool-temperature dialysis lessens this phenomenon. Ten patients who were prone to intradialytic hypotension entered a randomized, crossover study to compare the development of dialysis-induced left ventricular (LV) regional wall motion abnormalities (RWMA) at dialysate temperatures of 37 and 35°C. Serial echocardiography with quantitative analysis was used to assess ejection fraction and regional systolic LV function. BP and hemodynamic variables were measured using continuous pulse wave analysis. The severity of thermal symptoms was scored using a simple questionnaire. Forty-nine new RWMA developed in nine patients during hemodialysis with dialysate at 37°C (HD 37 ), compared with thirteen RWMA that developed in four patients during HD 35 (odds ratio 3.8; 95% confidence interval 2.1 to 6.9). The majority of RWMA displayed improved function by 30 min after dialysis. Overall, regional systolic LV function was significantly more impaired during HD 37 (P < 0.001). BP was higher during HD 35 , with fewer episodes of hypotension as a result of a higher peripheral resistance and no difference in stroke volume. The development of thermal symptoms was heterogeneous, with most patients tolerating HD 35 well. This study confirms previous findings of reversible LV RWMA that develop during hemodialysis. It also shows that this phenomenon can be ameliorated by reducing dialysate temperature, a simple intervention with no cost implications.

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“…The evidence of HD-induced myocardial ischemia came from electrocardiogram-based studies and isotopic perfusion imaging. Zuber et al demonstrated silent ST-depression occurring during hemodialysis [21] and its rates varied between 15 to 40% in next studies [22][23][24]. Singh et al observed the dialysis-induced myocardial perfusion defects in seven of ten patients, examined by single-photon emission computed tomography [25].…”

Section: Discussionmentioning

confidence: 99%

Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T

Wajdlich

Podlejska²,

Rosół³

et al. 2017

Arterial Hypertension

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Effect of hydration status and variability of blood pressure and heart rate induced by hemodialysis on intradialytic changes of high sensitive troponin T Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T AbstractIntroduction. High sensitivity troponin T (TnT-hs) is biomarker of myocardial damage and ischemia. Despite its elevation troponin still preserve its usefulness as a marker of the cardiovascular risk and mortality in chronic kidney disease. Variations of hydration status between and during hemodialysis exert significant hemodynamic effects, which may negatively affect cardiovascular system and blood pressure and lead to myocardial damage. The aim of the study was to access the effect of hydration status and variability of blood pressure and heart rate induced by hemodialysis on intradialytic changes of TnT-hs, in chronic hemodialysis patients. Material and methods. In 50 chronic hemodialysis patients (35M, 15F, mean age 64 ± 12 years) blood pressure and heart rate were monitored noninvasively during HD session. Serum concentration of TnT-hs and hydration status were assessed before and after hemodialysis.Results. TnT-hs concentration was above normal range in 98% patients before, and in all after hemodialysis. Median TnT-hs level was 82 ng/L before and 84 ng/L after hemodialysis, which comprised 586% and 600% of the upper limit of normal range. There was a small 2.4%, intradialytic increase of TnT-hs (p = 0.004). TnT-hs levels correlated positively with mean interdialytic weigh gain, before HD (r = 0.43, p = 0.02) and after HD (r = 0.5, p = 0.003).There was also a positive correlation between TnT-hs concentration and mean heart rate (r = 0.37, p = 0.008) and with mean systolic blood pressure during HD, before HD (r = 0.3, p = 0.026) and after HD (r = 0.3, p = 0.031). Conclusions. Hemodialysis can be a risk factor of myocardial injury, especially in overhydrated patients. Key words: hemodialysis, overhydration, troponin T, TnT-hs Arterial Hypertens. 2017, vol. 21, no. 4, pages: 186-194 DOI: 10.5603 StreszczenieWstęp. Wysokoczuła troponina T (TnT-hs) jest przydatnym klinicznie wskaźnikiem uszkodzenia komórek mięśnia sercowego. Stężenia TnT-hs u pacjentów z przewlekłą chorobą nerek są wyższe niż w populacji ogólnej, co wiąże się ze zwiększonym ryzykiem incydentów sercowo-naczyniowych oraz zgonu. Znaczne zmiany stopnia nawodnienia w czasie zabiegu hemodializy mogą niekorzystnie oddziaływać na układ sercowo-naczyniowy i ciśnienie tętnicze, co w efekcie może prowadzić do uszkodzenia kardiomiocytów. Celem pracy była ocena wpływu stanu nawodnienia, zmian częstości rytmu serca (HR) i ciśnienia tętniczego (BP) w trakcie hemodializy (HD) na zmiany stężeń TnT-hs powodowane zabiegiem hemodializy u pacjentów długotrwale hemodializowanych. Materiał i metody. U 50 pacjentów (35M, 15K, średnia wieku 64 ± 12 lat) z rozpoznaniem schyłkowej niewydolności nerek, długotrwale hemodializowanych, nieinwazy...

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ECG changes and cardiac arrhythmias in chronic renal failure patients on hemodialysis

Cited by 70 publications

References 21 publications

P Wave Dispersion Increases during Hemodialysis Sessions

P Wave Dispersion Increases during Hemodialysis Sessions

Dialysis-Induced Regional Left Ventricular Dysfunction Is Ameliorated by Cooling the Dialysate

Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T

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