SUN-083 ELECTROCARDIOGRAPHIC INDICES AND PERIPHERAL VASCULAR DISEASE AMONG PREDIALYTIC CKD PATIENTS

Abstract

Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. It is not known whether abnormalities of cardiac rhythm are associated with bio-impedance measurements or whether resting electrocardiographic findings are associated with peripheral vascular disease (PVD) in the CKD setting. The study design was cross-sectional, case-control in nature. After exclusion of heart disease, atrial fibrillation, implantable pacemaker, or use of anti-arrhythmic drugs, 90 participants were analysed comprising of 45 predialytic CKD patients and 45 age- and sex-matched controls. CKD was defined by an estimated eGFR < 60ml/min/1.73m2. All patients underwent 12 lead electrocardiogram (ECG) and bioelectric impedance assessment. ECG abnormalities were defined based on accepted standard criteria. Phase angle was calculated as arctangent of (X/R). Peripheral vascular disease was estimated using ankle-brachial index (ABI). Baseline characteristics of study participants is as shown in table 1. Patients with CKD had prolonged QRS interval [Median (IQR); 92.0 (86.0-96.0) vs 82.0 (77.0-86.0), p<0.001], higher prevalence of left ventricular hypertrophy (33.3% vs 8.9%, p=0.004) and lower impedance values [Median (IQR); 471.0 (427.0-516.0) vs 512.0 (470.5-571.5), p=0.018] compared with those without CKD. Prevalence of PVD was 31.1% in CKD patients compared to 11.1% in non-CKD patients. Phase angle correlated with heart rate (r = -0.351; p=0.001), prolonged QRS duration (r=0.278; p=0.010) and prolonged corrected QT (QTc) interval (r = -0.248; p=0.022) while eGFR correlated with impedance (r=0.313; p=0.004), prolonged QRS duration (r = -0.404; p<0.001), prolonged QTc (r = -0.224; p=0.036), ABI (right; r = -0.284; p=0.008, left: r = -0.262; p=0.014). After adjustment for eGFR, age, gender, blood pressure, and phase angle, LVH was associated with 65-fold greater risk for PVD (95% CI: (1.05 – 4073.54, p=0.047) while prolonged QRS interval was associated with 1.2 fold rise in PVD (95% CI: (1.02 – 1.39, p=0.023). Resting electrocardiographic abnormalities are common in predialytic CKD patients, correlated with BIA parameters and independently predict PVD in predialytic CKD.