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      QT Interval and QT Dispersion in Patients Undergoing Hemodialysis: Revisiting the Old Theory

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          Abstract

          Aims: We sought to explore the response of the corrected QT (QTc) interval duration and QT dispersion (QTD) to hemodialysis. Methods: We enrolled 50 patients with end-stage renal disease undergoing regular hemodialysis. Blood samples were drawn for measurement of serum electrolytes, and a 12-lead ECG was performed to measure the QTc interval duration and QTD, immediately before and just after dialysis sessions. Results: The mean age of the cohort was 42.8 ± 12.2 years (58% males). Both the QTc duration and QTD showed marked variability after hemodialysis. A significant correlation was found between the decrease of both serum potassium and magnesium levels after dialysis and the post-dialysis QTc interval duration, with Pearson’s correlation coefficients r = –0.43 and r = –0.34, p = 0.002 and p = 0.01, respectively. Patients with a post-dialysis increase of QTc interval duration had a significantly higher percentage of reduction of serum potassium (p = 0.029), whereas patients with a post-dialysis increase of QTD had a significantly higher percentage of reduction of serum magnesium (p = 0.03). Conclusion: Our findings suggest a highly variable response of the QTc interval duration and QTD to hemodialysis. The post-dialysis QTc interval duration inversely correlated with the decrease of both serum potassium and magnesium levels after dialysis.

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          An analysis of the time‐relations of electrocardiograms

          H Bazett, HC Bazett, H. C. Bazett … (1920)
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            QT dispersion.

            James P Higham, Robert Campbell (1994)
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              Haemodialysis increases QT(c) interval but not QT(c) dispersion in ESRD patients without manifest cardiac disease.

              Mirela Diaconita, Maria Covic, Paul Gusbeth-Tatomir … (2002)
              HD has been reported to determine an increase in QTc interval and QTc dispersion (QT(max)-QT(min))-risk factors that predispose to severe ventricular arrhythmias and sudden death. However, most studies have included end-stage renal disease (ESRD) patients with significant heart pathology. We therefore aimed to study the impact of a single HD session in subjects without manifest cardiac disease. Sixty-eight stable, non-diabetic HD patients (47.1% males, age 40.2+/-12.7 years, HD duration 57+/-36 months and 37% hypertensive), with normal maximal ECG stress test and sub-endocardiac viability index and without ECG left ventricular hypertrophy were included. QT interval was calculated 10 min pre- and post-HD, as an average of three consecutive complexes, and corrected for heart rate using Bazett's formula (QTc=QT/(R-R)(1/2)). Na(+), K(+), Ca(2+), PO(4), pH and BP levels were also determined pre- and post-HD. The QTc interval increased significantly post-HD to 434+/-29 from 421+/-26 ms pre-HD (P=0.005); an abnormally prolonged QTc (>440 ms) was recorded in 34% cases pre-HD and in 46% post-HD, i.e. 1.5-2.3 times higher than in the high risk EURODIAB IDDM population. However, this effect was not homogeneous. Only 47 subjects had an increase in QTc duration after a dialysis session, while in 21 a decrease in QTc duration was recorded. The increase in QTc post-HD correlated with Ca(2+) homeostasis. Patients with greater increases in QTc after dialysis had higher baseline plasma calcium levels (r=0.47, P<0.001); also, a larger decrease in Ca(2+) post-HD correlated with higher increases in QTc interval (r=0.33, P<0.05). In contrast with QTc behaviour and with data from the literature, in this young HD population without manifest cardiac disease and with a low prevalence of HTA, post-HD QTc dispersion was similar to pre-HD values, increasing in only 39 patients. Furthermore, changes in QTc dispersion were not related to changes in electrolytes and BP following dialysis. However, changes in QTc dispersion and in QTc interval were directly correlated (r=0.37, P=0.42). There were no relationships between pre-HD measured echocardiographic variables, including: LV ejection fraction, internal diameters, wall thickness, mass and mass index and baseline or changes in QTc or QTc-d. Haemodialysis increases the QTc interval in ESRD patients, mainly related to rapid changes in electrolyte plasma concentrations. However, the impact on QTc dispersion is less important in the absence of significant coexisting cardiac disease.
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                Author and article information

                Journal
                Journal ID (publisher-id): NNE
                Journal ID (pmc): NNE
                Journal ID (doi): 10.1159/issn.1664-5529
                Title: Nephron Extra
                Publisher: S. Karger AG
                ISSN (Electronic): 1664-5529
                Publication date Subscription-year: 2011
                Publication date Collection: July – December 2011
                Publication date (Electronic): 09 July 2011
                Volume: 1
                Issue: 1
                Pages: 1-8
                Affiliations
                aCardiology Department and bNephrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
                Author notes
                *Wail Nammas, Cardiology Department, Ain Shams University Hospitals, Faculty of Medicine, Ain Shams University, PO 11381, Abbassia, Cairo (Egypt), Tel. +20 12 406 3718, E-Mail wnammas@hotmail.com
                Article
                Publisher ID: 328930 Pmcid ID: PMC3290838 Other ID: Nephron Extra 2011;1:1–8
                DOI: 10.1159/000328930
                PMC ID: PMC3290838
                PubMed ID: 22470374
                SO-VID: 56da6888-0fd2-4d56-989f-37ff86283a16
                Copyright © © 2011 S. Karger AG, Basel
                License:

                Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) ( http://www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date accepted : 07 June 2011
                Page count
                Figures: 2, Tables: 2, Pages: 8
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Hemodialysis,QT interval,QT dispersion
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Hemodialysis, QT interval, QT dispersion

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