Abstract
P wave parameters measured by 12-lead electrocardiogram (ECG) are commonly used as a noninvasive tool to evaluate left atrial enlargement. This study was designed to assess whether P wave parameters were associated with renal outcomes in chronic kidney disease (CKD) patients. This longitudinal study enrolled 439 patients with CKD stages 3–5. Renal end points were defined as the commencement of dialysis or death. Change in renal function was measured using the estimated glomerular filtration rate (eGFR) slope. We measured two ECG P wave parameters corrected for heart rate, i.e., corrected P wave dispersion and corrected maximum P wave duration. The values of P wave dispersion and maximum P wave duration were 88.8±21.7 ms and 153.3±21.7 ms, respectively. During the follow-up period (mean, 25.2 months), 95 patients (21.6%) started hemodialysis and 30 deaths (6.8%) were recorded. Multivariate Cox regression analysis identified that increased P wave dispersion [hazard ratio (HR), 1.020; 95% confidence interval (CI), 1.009–1.032; P<0.001] and maximum P wave duration (HR, 1.013; 95% CI, 1.003–1.024; P = 0.012) were associated with progression to renal end points. Furthermore, increased P wave dispersion (unstandardized coefficient β = –0.016; P = 0.037) and maximum P wave duration (unstandardized coefficient β = –0.014; P = 0.040) were negatively associated with the eGFR slope. We demonstrated that increased P wave dispersion and maximum P wave duration were associated with progression to the renal end points of dialysis or death and faster renal function decline in CKD patients. Screening CKD patients on the basis of P wave dispersion and maximum P wave duration may help identify patients at high risk for worse renal outcomes.
Highlights
Both traditional risk factors, such as hypertension, diabetes, and dyslipidemia, and non-traditional risk factors, such as cardiovascular disease contribute to the risk of progressive renal function loss [1,2]
We evaluated the association of P wave parameters with kidney disease progression to dialysis or death and the rate of renal function decline in patients with chronic kidney disease (CKD) stages 3–5
We recently reported that concentric left ventricular hypertrophy (LVH), increased left atrial diameter, and decreased left ventricular ejection fraction were associated with adverse renal outcomes [5,6]
Summary
Both traditional risk factors, such as hypertension, diabetes, and dyslipidemia, and non-traditional risk factors, such as cardiovascular disease contribute to the risk of progressive renal function loss [1,2]. Echocardiographic measures of left ventricular function and structure as well as left atrial size have been reported to predict adverse renal outcomes [5,6,7] This implies that patients with cardiac dysfunction and left atrial enlargement might have faster renal function decline and adverse renal outcome. P wave parameters measured by 12-lead ECG have been reported to be useful tools for assessing the risk of left atrial enlargement, left ventricular hypertrophy (LVH), and left ventricular diastolic dysfunction [9,10,11,12,13,14,15,16,17]. There are limited studies evaluating whether P wave parameters are associated with progression to end-stage renal disease, decline in renal function, or death in CKD patients. The aim of this study in a cohort of patients with CKD stages 3–5 were to assess whether P wave parameters were associated with progression to the commencement of dialysis or death and whether these parameters were associated with the rate of renal function decline
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