Abstract
Objective: The risks of sudden death and cardiac arrhythmia are increased in patients with chronic kidney disease (CKD). Here, we aimed to evaluate the indicators of arrhythmias, such as p-wave dispersion (P-WD), QTc dispersion, Tp-e and Tp-e/QT ratio in patients with CKD stages 3–5 on no renal replacement therapy (RRT). Material and methods: One-hundred and thirty three patients with CKD stages 3–5 and 32 healthy controls were enrolled into the study. No patients received RRT. QTc dispersion, P-WD and Tp-e interval were measured using electrocardiogram and Tp-e/QT ratio was also calculated. Results: Mean age rates were found similar in patients and controls (60.8 ± 14.2 and 61 ± 12.9 y, p = .937, respectively). Compared patients with controls, P-WD (45.85 ± 12.42 vs. 21.17 ± 6.6 msec, p < .001), QTc-min (366.99 ± 42.31 vs. 387.15 ± 20.5 msec, p < .001), QTc dispersion (71.13 ± 27.95 vs. 41.25 ± 14.55 msec, p < .001), Tp-e maximum (81.04 ± 10.34 vs. 75.49 ± 10.9 msec, p < .001), Tp-e minimum (62.25 ± 7.58 vs. 54.8 ± 6.72 msec, p < .001) and Tp-e/QTc ratio (0.19 ± 0.02 vs. 0.18 ± 0.01, p = .001) were found to be different. QTc-max and Tp-e interval were found to be similar in both groups. Conclusion: P-WD and QTc dispersion, Tp-e interval and Tp-e/QTc ratio were found to be increased in with CKD stages 3–5 on no RRT.
Highlights
Chronic kidney disease (CKD) is among important health problems across the world, and it is known that cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with CKD [1,2]
The values of P-wave dispersion (P-WD), QTc dispersion and Tp-e/QT ratio were found to increase in predialysis patients with stages 3–5 CKD on no renal replacement therapy (RRT)
In a study performed by Dilaveris et al [5], a cutoff value is recommended as 110 msec (88% of sensitivity and 83% of specifity) for Pmax and as 40 msec (75% of sensitivity and 85% of specifity) for P-WD in order to distinguish the healthy controls from the patients
Summary
Chronic kidney disease (CKD) is among important health problems across the world, and it is known that cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with CKD [1,2]. Hemodialysis patients characteristically exhibit left ventricular (LV) hypertrophy, reduced peripheral arterial compliance, impaired microcirculation [27] and ineffective vasoregulation (in response to hemodialysis with ultrafiltration) All of these factors predispose to demand ischemia. Apart from conventional risk factors of sudden cardiac death studied in the general population, patients with chronical renal disease have distinct underlying pathologies predisposing them to these events and possibly have different relative impacts. Among these are myocardial hypertrophy, left ventricular diastolic dysfunction, myocardial fibrosis, microvessel disease, dialysisinduced myocardial injury and stunning, disorders of mineral metabolism and secondary hyperparathyroidism. We aimed to evaluate P-WD, QTc dispersion, Tp-e and Tp-e/QT ratio in patients with CKD at stages 3–5 not on RRT in order to assess atrial and ventriculary repolarisation
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