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      Electrocardiographic Changes during Hemodiafiltration with Different Potassium Removal Rates

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          Background/Aims: Sudden K removal is thought to be implicated in ECG alterations observed during hemodialysis (HD). The effects of the K removal rate on ECG-derived parameters have been investigated. Methods: Two different hemodiafiltration (HDF) schedules were used for 10 HD patients: the dialysate K concentration was kept constant in HDF<sub>st</sub>, while in HDF<sub>K</sub> it was decreased during the session in order to maintain a uniform plasma-dialysate K gradient. A 12-lead Holter monitor was used to acquire the ECG in the course of the treatments. Classical ECG parameters and overall indices for quantifying ventricular repolarization abnormalities were evaluated. Results: Several ECG parameters were affected by both HD therapies (ST depression, QRS amplitude and QT dispersion), but only indices of the homogeneity of repolarization (PCA-T, E1-T) were significantly affected by the K removal rate. Conclusion: The present study confirms the large impact of HD therapy on ECG. The analysis of the spatial T wave complexity points out the intrinsic arrhythmogenic implications of the K removal rate.

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          Most cited references 5

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          Effect of Hemodialysis on the Dispersion of the QTc Interval

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            Application of the ambulatory 24-hour electrocardiogram in the prediction of cardiac death in dialysis patients.

            The value of a 24-hour ambulatory electrocardiogram (AmECG) in assessing the risk of cardiac death was studied in 122 stable-condition dialysis patients followed up from two to six years after monitoring. An abnormal AmECG was defined by second-degree or greater AV block or by Lown grade 3 or greater ventricular ectopy. The incidence of cardiac mortality or an abnormal AmECG was not influenced by hypokalemia or beta-blockers. Digitalis was associated with both an abnormal AmECG and a twofold increase in mortality whether or not the AmECG was normal. Cardiac mortality accounted for 26 of 33 deaths within the first year after the AmECG. In the absence of coronary artery disease, survival at six months was 100% in patients with normal AmECG vs 90% (abnormal AmECG). In the presence of coronary artery disease, survival at six months was 83% (normal AmECG) vs 54% (abnormal AmECG).
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              Hemodialysis changes the QRS amplitude in the electrocardiogram.

              We studied eight patients to determine whether changes occur in the QRS amplitude when these patients are submitted to hemodialysis. The following variables were assessed before and after each (N = 28) hemodialysis session: (1) plasma sodium and potassium concentrations, (2) QRS amplitude, (3) the heart rate and its variability, (4) ventricular volumes, ventricular mass, ejection fraction and circumferential fiber shortening, (5) arterial pressure and end systolic stress, and (6) body weight. QRS amplitude was computed as the algebraic sum of the positive and negative waves of each QRS complex of the electrocardiogram. QRS amplitude changes were compared to body weight, ventricular volumes, ventricular mass, ejection fraction, circumferential fiber shortening, plasma potassium and sodium concentrations, arterial pressure, end systolic stress, heart rate, and R-R variability. After the hemodialysis sessions we found a significant increase (P = 0.0006) in QRS amplitude and a significant decrease in body weight (P = 0.0001), end diastolic volume (P = 0.043), plasma potassium concentration (P = 0.000001), end systolic stress (P = 0.025) and systolic arterial pressure (P = 0.023). Hemodialysis did not produce significant changes in the other variables. The statistical analyses performed did not show any significant influence of any of the measured variables on the QRS amplitude change. The QRS amplitude increases after hemodialysis but the cause of this increase is still unclear.

                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                03 November 2003
                : 21
                : 6
                : 381-388
                aBiomedical Engineering Laboratory, DEIS, University of Bologna, and bMalpighi Nephrology Division, Policlinico S. Orsola-Malpighi, Bologna, Italy; cRegional Medical Physics Department, Freeman Hospital, NewcastleuponTyne,UK
                73440 Blood Purif 2003;21:381–388
                © 2003 S. Karger AG, Basel

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                Page count
                Figures: 5, Tables: 4, References: 30, Pages: 8
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/73440
                Original Paper


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