Changes in QTc interval in long-term hemodialysis patients.

Yoshihiro Matsumoto,Yohichi Nojima,Toshikazu Sugiyama,Yasuo Mori,Koichiro Iguchi,Yasushi Shimada,Shinji Kageyama,Kazuo Arihara,Hidemaro Sato,Kijun Nagata

doi:10.1371/journal.pone.0209297

Yoshihiro Matsumoto, Yohichi Nojima + Show 8 more

Open Access

https://doi.org/10.1371/journal.pone.0209297

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Journal: PloS one	Publication Date: Jan 3, 2019
Citations: 14	License type: CC BY 4.0

Affiliation: Shizuoka City Hospital, Shizuoka Medical Center

Abstract

BackgroundCardiovascular diseases, including sudden cardiac death (SCD), are the leading cause of death in hemodialysis (HD) patients. A prolonged QT interval on the electrocardiogram (ECG) is a risk factor for SCD in HD patients. This study investigated whether the heart rate-corrected QT (QTc) interval becomes prolonged along with dialysis vintage.MethodsA total of 102 HD patients were retrospectively studied. Their ECG data were analyzed at 1, 4, and 7 years after HD initiation. The control group comprised 68 age-matched individuals who had normal renal function and two available ECG reports at an interval of more than 4 years. QTc was measured according to the Bazett formula. The association between QTc interval and dialysis vintage was studied. Additionally, clinically relevant variables related to QTc duration at 1 year after HD initiation were assessed.ResultsAverage QTc interval at 4 and 7 years after HD initiation was significantly longer than that at 1 year after HD initiation (443, 445, and 437 ms) (p<0.05). On the other hand, QTc interval in the control group was 425 ms in the first year and 426 ms after an average of 6 years. They had no significant differences, although they were much shorter than that in HD patients. Multivariate regression analysis of baseline variables revealed that the corrected calcium levels (p = 0.041) and diabetes (p = 0.043) were independently associated with longer QTc interval.ConclusionsThe QTc interval at 1 year after HD initiation was longer than in the control subjects and was prolonged over several years of HD treatment. Providing clinical management with a focus on QTc interval may be helpful for reducing the incidence of SCD in HD patients.

Highlights

Patients with end-stage renal disease (ESRD) undergoing dialysis are at a high risk of cardiovascular disease (CVD)
Multivariate regression analysis of baseline variables revealed that the corrected calcium levels (p = 0.041) and diabetes (p = 0.043) were independently associated with longer QTc interval
Providing clinical management with a focus on QTc interval may be helpful for reducing the incidence of sudden cardiac death (SCD) in HD patients

Summary

Introduction

Patients with end-stage renal disease (ESRD) undergoing dialysis are at a high risk of cardiovascular disease (CVD). Sudden cardiac death (SCD) is the most common cause of mortality in these patients, accounting for >25% of all deaths in United States [1]. Unlike in the general population, coronary artery disease is not a major cause of SCD in dialysis patients. A retrospective study reported that 71% of dialysis patients who died of SCD had either normal left ventricular (LV) function or mild-to-moderate dysfunction [3]. A small study using an implantable cardiac monitor in stable hemodialysis (HD) patients with more than 35% of LV function revealed that at least 4 of 5 SCD events occurred with severe bradycardia and ensuring asystole [4]. Cardiovascular diseases, including sudden cardiac death (SCD), are the leading cause of death in hemodialysis (HD) patients. This study investigated whether the heart ratecorrected QT (QTc) interval becomes prolonged along with dialysis vintage

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Conclusion