Frailty severity is significantly associated with electrocardiographic QRS duration in chronic dialysis patients.

Chia-Ter Chao,Jenq-Wen Huang

doi:10.7717/peerj.1354

Chia-Ter Chao, Jenq-Wen Huang

Open Access

https://doi.org/10.7717/peerj.1354

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Abstract

End-stage renal disease (ESRD) patients are at increased risk of sudden cardiac death, the risk of which is presumably related to arrhythmia. Electrocardiographic (ECG) parameters have been found to correlate with arrhythmia and predict cardiovascular outcomes in ESRD patients. Frailty is also a common feature in this population. We investigate whether the severity of dialysis frailty is associated with ECG findings, including PR interval, QRS duration, and QTc interval. Presence and severity of frailty was ascertained using six different self-report questionnaires with proven construct validity. Correlation analysis between frailty severity and ECG was made, and those with significant association entered into multiple regression analysis for confirmation. Among a cohort of chronic hemodialysis patients, we found that frailty severity, assessed by the Edmonton frailty scale, is significantly associated with QRS duration (r = − 0.3, p < 0.05). Dialysis patients with QRS longer than 120 ms had significantly lower severity of frailty than those with QRS less than 120 ms (p = 0.01 for the Edmonton frailty scale and 0.05 for simple FRAIL scale). Regression analysis showed that frailty severity, assessed by the Edmonton frailty scale and simple FRAIL scale, was significantly associated with QRS duration independent of serum electrolyte levels. In conclusion, a significant relationship exists between the severity of frailty and QRS duration in ESRD patients. This might be an under-recognized link between frailty and its adverse cardiovascular impact in these patients.

Highlights

Among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients, the combination of traditional risk factors (hypertension, diabetes mellitus (DM), and smoking) and non-classical features contribute to the very high risk of cardiovascular events, especially sudden cardiac death (SCD) (Shlipak et al, 2005)
Using the six screening instruments, we identified that 22%, 32% (Tilburg frailty indicator), 46% (Edmonton frailty scale), 56%
We found that QRS duration correlated significantly with frailty severity, using scores from the Edmonton frailty scale (p = 0.049) (Fig. 1) and borderline significantly with the scores from Simple

Summary

Introduction

Among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients, the combination of traditional risk factors (hypertension, diabetes mellitus (DM), and smoking) and non-classical features (inflammation, malnutrition, vascular calcification) contribute to the very high risk of cardiovascular events, especially sudden cardiac death (SCD) (Shlipak et al, 2005). Referring to death from presumable cardiac origin within one hour of symptom-onset, SCD claims nearly a quarter of all mortality cases in chronic dialysis patients, emerging as a serious public health concern (Passman & Herzog, 2011). Half of these deaths are likely triggered by fatal arrhythmia (ventricular tachycardia/fibrillation), superimposed on susceptible substrates with myocardial ischemia or systolic dysfunction (Wang et al, 2010). Electrocardiographic alterations, such as QTc interval alterations and repolarization dispersions, have been reported to be pathogenic in ventricular arrhythmia among chronic hemodialysis patients, serving as potential risk factors for SCD (Kalantzi et al, 2013)

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