Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD

Deo, Rajat; Shou, Haochang; Soliman, Elsayed Z.; Yang, Wei; Arkin, Joshua M.; Zhang, Xiaoming; Townsend, Raymond R.; Go, Alan S.; Shlipak, Michael G.; Feldman, Harold I.

doi:10.1681/asn.2014101045

Cited by 58 publications

(44 citation statements)

References 36 publications

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“…28 Other ECG metrics derived from a 12-lead ECG have also been shown to be predictive of cardiovascular mortality in those with CKD before starting hemodialysis; however, we report no significant associations of the standard ECG parameters with mortality, and the magnitude of effect is not as great as with spatial QRS-T angle. 29 The role of ECG monitoring has not been a central focus in the clinical management of patients on dialysis, and therefore, the inclusion of the spatial QRS-T angle and its effect on clinical decision making need to be considered.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiologic Substrate and Risk of Mortality in Incident Hemodialysis

Tereshchenko¹,

Kim

Oehler

et al. 2016

JASN

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The single leading cause of mortality on hemodialysis is sudden cardiac death. Whether measures of electrophysiologic substrate independently associate with mortality is unknown. We examined measures of electrophysiologic substrate in a prospective cohort of 571 patients on incident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease Study. A total of 358 participants completed both baseline 5-minute and 12-lead electrocardiogram recordings on a nondialysis day. Measures of electrophysiologic substrate included ventricular late potentials by the signal-averaged electrocardiogram and spatial mean QRS-T angle measured on the averaged beat recorded within a median of 106 days (interquartile range, 78-151 days) from dialysis initiation. The cohort was 59% men, and 73% were black, with a mean±SD age of 55±13 years. Transthoracic echocardiography revealed a mean±SD ejection fraction of 65.5%±12.0% and a mean±SD left ventricular mass index of 66.6±22.3 g/m During 864.6 person-years of follow-up, 77 patients died; 35 died from cardiovascular causes, of which 15 were sudden cardiac deaths. By Cox regression analysis, QRS-T angle ≥75° significantly associated with increased risk of cardiovascular mortality (hazard ratio, 2.99; 95% confidence interval, 1.31 to 6.82) and sudden cardiac death (hazard ratio, 4.52; 95% confidence interval, 1.17 to 17.40) after multivariable adjustment for demographic, cardiovascular, and dialysis factors. Abnormal signal-averaged electrocardiogram measures did not associate with mortality. In conclusion, spatial QRS-T angle but not abnormal signal-averaged electrocardiogram significantly associates with cardiovascular mortality and sudden cardiac death independent of traditional risk factors in patients starting hemodialysis.

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Section: Discussionmentioning

confidence: 99%

Electrophysiologic Substrate and Risk of Mortality in Incident Hemodialysis

Tereshchenko¹,

Kim

Oehler

et al. 2016

JASN

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“…When these measures were added to traditional models to predict CV events, it improved the prediction capability and a substantial number of patients (more than 12%) were re‐classified as high risk. Further studies are warranted to assess if ECG in addition to other information can identify patients for more intensive CV risk reduction management …”

Section: Chronic Kidney Diseasementioning

confidence: 99%

Recent advances in CKD and ESRD: A literature update

Chopra

Rosner

2016

Hemodialysis International

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“…Competing risks exist when an individual can experience other types of events that prevent the occurrence of the event of interest, thereby preventing us from knowing when that individual would have developed the event of interest had the competing event not have happened (1). For example, death precludes us from observing CKD outcomes such as ESRD (2,3), or cardiovascular disease (CVD) outcomes such as coronary artery disease or congestive heart failure (4,5).…”

Section: Introductionmentioning

confidence: 99%

Statistical Methods for Cohort Studies of CKD: Survival Analysis in the Setting of Competing Risks

Hsu

Roy

Xie

et al. 2017

CJASN

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Survival analysis is commonly used to evaluate factors associated with time to an event of interest ( ESRD, cardiovascular disease, and mortality) among CKD populations. Time to the event of interest is typically observed only for some participants. Other participants have their event time censored because of the end of the study, death, withdrawal from the study, or some other competing event. Classic survival analysis methods, such as Cox proportional hazards regression, rely on the assumption that any censoring is independent of the event of interest. However, in most clinical settings, such as in CKD populations, this assumption is unlikely to be true. For example, participants whose follow-up time is censored because of health-related death likely would have had a shorter time to ESRD, had they not died. These types of competing events that cause dependent censoring are referred to as competing risks. Here, we first describe common circumstances in clinical renal research where competing risks operate and then review statistical approaches for dealing with competing risks. We compare two of the most popular analytical methods used in settings of competing risks: cause-specific hazards models and the Fine and Gray approach (subdistribution hazards models). We also discuss practical recommendations for analysis and interpretation of survival data that incorporate competing risks. To demonstrate each of the analytical tools, we use a study of fibroblast growth factor 23 and risks of mortality and ESRD in participants with CKD from the Chronic Renal Insufficiency Cohort Study.

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Electrocardiographic Measures and Prediction of Cardiovascular and Noncardiovascular Death in CKD

Cited by 58 publications

References 36 publications

Electrophysiologic Substrate and Risk of Mortality in Incident Hemodialysis

Electrophysiologic Substrate and Risk of Mortality in Incident Hemodialysis

Recent advances in CKD and ESRD: A literature update

Statistical Methods for Cohort Studies of CKD: Survival Analysis in the Setting of Competing Risks

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