Electrocardiogram Abnormalities and Cardiovascular Mortality in Elderly Patients with CKD

Abstract

SummaryBackground and objectives Cardiovascular disease is the most common cause of death in CKD. This study evaluated whether electrocardiogram (ECG) abnormalities are predictors of cardiovascular death in CKD.Design, setting, participants, & measurements The Cardiovascular Health Study limited database (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005) was used to identify a cohort with CKD at baseline (estimated GFR , 60 mL/min per 1.73 m 2 ). The patients were categorized as having major, minor, or no ECG abnormalities. Rates of adjudicated cardiovascular events and mortality were compared among the groups using proportional hazards regression models.Results A total of 1192 participants had CKD at baseline; mean age 6 SD was 74.766.2 years. Of these patients, 452 (38.8%) had major, 346 (29.7%) had minor, and 367 (31.5%) had no ECG abnormalities. Participants with estimated GFR , 60 mL/min per 1.73 m 2 were more likely to have ECG abnormalities at baseline (adjusted prevalence odds ratio, 1.23 [95% confidence interval (CI), 1.06-1.43]) than those with GFR $ 60 mL/min per 1.73 m 2 . During mean follow-up of 10.363.8 years, 814 (68.3%) participants died. Compared with participants without ECG abnormalities, participants with major abnormalities had the highest risk for cardiovascular events and death; adjusted hazard ratios were 2.15 (95% CI, 1.56-2.98) and 2.27 (95% CI, 1.56-3.30), respectively. For minor ECG abnormalities, hazard ratios were 1.24 (95% CI, 0.91-1.70) and 1.48 (95% CI, 1.00-2.18), respectively. ConclusionsIn patients with CKD, major ECG abnormalities are frequently present and predict a significantly higher risk for death and adverse cardiovascular outcomes.

Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD

“…In communitybased elderly participants with early CKD, ECG measures were independently associated with all-cause mortality. 6,7 The mean age in these studies was 75 years, the mean eGFR was 50-60 ml/min per 1.73m 2 and greater than 80% of the study population was white thus limiting the generalizability of these findings to a larger CKD population, especially those with moderate to advanced CKD. In contrast, among participants with end stage renal disease on hemodialysis from the German Diabetes and Dialysis (4D) Study, common ECG measures including the QRS duration, QT interval and heart rate were not independently associated with clinical events.…”

Electrocardiographic Abnormalities and Cardiovascular Disease Risk in Type 1 Diabetes: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study

“…This does not, of course, obviate the need to refine a prediction score specific to type 1 diabetes, and ECG may be of help in this regard, given the magnitude of the association between major ECG abnormalities and CVD events we observed in patients with type 1 diabetes, which is stronger than the association observed in other populations who are even older and have more comorbidities. For example, the more than twofold association (HR 2.19) between major ECG abnormalities and CVD events in type 1 diabetes compares with only an 83% increased risk of CVD events (HR 1.83 [95% CI 1.12, 2.97]) in an HIV-infected population (age 43.5 ± 9.3 years) (10), a 47% increased risk of coronary heart disease events (1.47 [1.16, 1.86]) in a general population of elderly patients (age 73.5 ± 2.8 years) (8), and a 115% increased risk of CVD events (2.15 [1.56, 2.98]) in patients with chronic kidney disease who are older than 65 years (9). Needless to say, the differences in age, sex, and race among these populations, as well as the definitions of outcomes, make it difficult to appropriately compare the magnitude of risk between major ECG abnormalities with CVD.…”

Quantitative Electrocardiographic Analysis in Relation to Renal Function in a Geriatric Population

“…Moreover, in elderly patients an increased frequency of ECG alterations in renal failure has been reported and some of these ECG alterations have been linked to increased cardiovascular mortality and morbidity [15,16], indicating their prognostic value. However, to the best of our knowledge there is no published data on the quantitative relationship between ECG alterations and renal function, which may be of relevance for the clinical evaluation of these patients.…”

“…The ECG has also been studied in patients with renal insufficiency [15,16] and microalbuminuria [17] and its alterations have been described previously. However, the relationship between ECG modifications and different degrees of renal failure has not been evaluated yet.…”