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. 2021 Apr 29;10(9):1933.
doi: 10.3390/jcm10091933.

Clinical Associations between Serial Electrocardiography Measurements and Sudden Cardiac Death in Patients with End-Stage Renal Disease Undergoing Hemodialysis

Hyun Jin Lee  1 , A Reum Choe  2 , HaeJu Lee  3 , Dong Ryeol Ryu  2 , Ea Wha Kang  4 , Jung Tak Park  5 , Su Hwan Lee  6 , Junbeom Park  7
Affiliations

Clinical Associations between Serial Electrocardiography Measurements and Sudden Cardiac Death in Patients with End-Stage Renal Disease Undergoing Hemodialysis

Hyun Jin Lee et al. J Clin Med. .

Abstract

The rate of sudden cardiac death (SCD) for hemodialysis (HD) patients is significantly higher than that observed in the general population and have the highest risk for arrhythmogenic death. In this multi-center study, patients starting hemodialysis in each hospital were enrolled; they underwent regular check-ups in an open-patient clinic. We examined serial electrocardiography (ECG) data in patients undergoing HD and determined their associations with the occurrence of SCD. Of 678 enrolled subjects who underwent serial ECG before and after hemodialysis, 291 died and 39 developed SCD. In all subjects, the QT peak-to-end (QTpe) interval at all leads and QRS duration were shortened after hemodialysis. The SCD group showed a significant change in the QTpe interval of the inferior, anterior, and lateral leads before and after hemodialysis compared with the survivor group (p < 0.001). In the pre-hemodialysis ECG, SCD patients had significantly longer QTpe intervals in all leads (p < 0.001) and a longer QRS duration (92.6 ± 14.0 vs. 100.6 ± 14.9 ms, p = 0.015) than survivors. In conclusion, patients with a longer QTpe interval before hemodialysis and large changes in ECG parameters after hemodialysis might be at a higher risk of SCD. Therefore, changes in the ECG before and after hemodialysis could help to predict SCD.

Keywords: arrhythmias; cardiac; critical care; death; electrocardiography; hemodialysis; kidney failure; sudden.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cause of death and proportion of sudden cardiac death in end-stage kidney disease (ESRD) patients. (A) Cause of death in ESRD patients. (B) Proportion of sudden cardiac death in ESRD patients.
Figure 2
Figure 2
Comparison of electrocardiography (ECG) change before and after hemodialysis (HD) using a linear mixed model. The change in QT peak-to-end (QTpe) interval before and after HD in the sudden cardiac death (SCD) group and the change in QTpe interval before and after HD in the survivor group were statistically significant. The SCD group showed a significantly larger change in the QTpe intervals of the inferior, anterior, and lateral leads after HD than the survivor group.
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