Haemodialysis Alters the Index of Cardiac-Electrophysiological Balance

Abstract

Objective: To study electrocardiographic changes during haemodialysis and determine the relationship between electrolyte alterations and acid-base balance.Study Design: Cross-sectional analytical study.
 Place and Duration of Study: Haemodialysis Unit, Combined Military Hospital, Peshawar Pakistan, from Jun to Jul 2022.
 Methodology: Adult patients with end-stage renal disease on maintenance hemodialysis were selected by convenience sampling. Exclusion criteria included current hospitalization, chest pain during haemodialysis, intra-dialytic hypotension,atrial fibrillation, pericardial effusion, shortening of haemodialysis sessions and unwillingness to participate in the study.Twelve lead electrocardiograms were recorded immediately before the start and end of haemodialysis sessions. At the same time, serum urea, creatinine, potassium, calcium and phosphate were measured. Bicarbonate levels were assessed by venous blood gas analysis. In addition, measurements for heart rate and durations of the PR interval, QRS complex, QT interval andcorrected QT interval reported by ECG machine software were recorded.
 Results: There were 35 patients with a mean age of 48.69±11.39 years. Duration of QRS complex increased from 92.83±9.98 to 100.00± 17.94 seconds after haemodialysis (p=0.017). Changes in other parameters were insignificant. QT/QRS and QTc/QRS ratios reduced by 0.27±0.62 and 0.31±0.62 after haemodialysis (p=0.014 and 0.005, respectively). Changes in none of the biochemical parameters during haemodialysis could predict the reduction in QT/QRS or QTc/QRS ratios.
 Conclusion: The reduction in the index of cardiac electrophysiological balance during hemodialysis was not related to intradialytic changes in different electrolytes or base content.

Comparative Analysis of Biochemical Profile in Patients with Chronic Renal Failure Undergoing Hemodialysis

“…In the context of this research, the analysis of serum sodium, potassium, and calcium levels before and after hemodialysis revealed significant deviations, underscoring the profound impact of the hemodialysis process on these essential electrolytes. These findings corroborate previous research by Arshad et al (2022), which similarly identified decreases in serum calcium and potassium levels post-hemodialysis (21). Contrarily, the study by Abdulla et al (2020) reported a decrease in sodium and calcium levels posthemodialysis, diverging from the current study's findings on sodium levels yet aligning with the observed potassium decrease (5).…”

“…Upon collection, the samples were immediately transported to the laboratory for analysis. To maintain the morphological integrity of the blood samples, they were stored in tubes with yellow caps and placed in carriers equipped with racks and ice packs to preserve a temperature range of 2-8 C (4,15,20,21). The biochemical profiles of the pre-and post-hemodialysis samples were then analyzed using a biochemistry analyzer, focusing on key parameters such as Sodium, Potassium, and Calcium.…”