Alterations in Atrial Electrophysiology after Hemodialysis

Abstract

Hemodialysis (HD) causes significant changes in hemodynamic status and metabolic milieu in chronic kidney disease patients (CKD). ECG parameters which reflect atrial electrophysiology, exemplified by p wave duration and p wave dispersion, may indirectly reflect these hemodynamic and metabolic changes. This study aimed to determine the effect of HD on the p wave duration (Pwd) and p wave dispersion (Pd) among patients with CKD. This is a prospective study of patients undergoing HD at the University of Santo Tomas Hospital. A 12 L ECG at a rate of 25 mm/sec was taken before and after hemodialysis. Pwd was measured with electronic digital caliper in all 12 leads. Pd, the difference between maximum and minimum Pwd, was measured. The maximum p wave duration (Pmax) and Pd were compared pre and post dialysis using paired students T-test. A total of 43 CKD patients with mean age of 55.23±14.3 were included in the study. Mean pre-dialysis Pmax was 72.44 plusmn; 6.58. Mean Post dialysis Pmax was 75.39±8.86. The mean difference between pre-dialysis and post dialysis Pmax was −2.95±5.55 (P 0.001). Mean pre-dialysis Pd was 15.51±5.64. Mean post dialysis Pd was 19.51±7.29. The mean difference between pre-dialysis and post-dialysis Pd was −4±6.2 (P 0.0001). Among CKD patients undergoing HD, in our study p wave duration and p wave dispersion significantly increased after hemodialysis indicating prolongation of atrial conduction time.