Key result
QTc prolongation, higher heart rate, and LVH linked to ~110% greater sudden death risk in hemodialysis.
Why the study?
Sudden death is a leading cause of death in hemodialysis patients, but the association between abnormal ECG findings and sudden death risk is not fully elucidated.
Do abnormal ECG parameters (higher heart rate, QTc prolongation, LVH) predict sudden death in patients receiving maintenance hemodialysis?
Cohort (n=1,153)
Yes
Do abnormal ECG parameters (higher heart rate, QTc prolongation, LVH) predict sudden death in patients receiving maintenance hemodialysis?
Hazard Ratio: 2.1 (95% CI 1.3–3.77)
p-value: p=0.01
Routine predialysis ECG parameters, specifically higher heart rate, QTc prolongation, and LVH, are independent predictors of sudden death in patients undergoing maintenance hemodialysis.
May support ECG-based risk stratification in hemodialysis; leaves open whether targeting these parameters reduces sudden death.
AIM: Sudden death is one of the most common causes of death among hemodialysis patients. Electrocardiography (ECG) is a noninvasive and inexpensive test that is regularly performed in hemodialysis clinics. However, the association between abnormal ECG findings and the risk of sudden death in hemodialysis patients is yet to be fully elucidated. Thus, the aim of this study was to determine the ECG parameters linked to sudden death in patients undergoing hemodialysis. METHODS: The Q-Cohort Study is a multicenter, longitudinal, observational study of hemodialysis patients. In this study, 1,153 Japanese hemodialysis patients aged ≥ 18 years with ECG data recorded within 1 year of study enrollment were followed up for 10 years. Cox proportional hazards models were used to estimate the multivariate-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between ECG parameters and sudden death. RESULTS: During the median follow-up period of 9.0 years, 517 patients died, 76 of whom exhibited sudden death. After adjusting for confounding factors, higher heart rate, QT prolongation, and left ventricular hypertrophy as per the Sokolow-Lyon voltage criteria were found to be independently associated with an increased risk of sudden death. The adjusted HRs [95% CIs] for each abnormal ECG parameter were 2.02 [1.05-3.89], 2.10 [1.30-1.77], and 1.91 [1.18-3.09], respectively. CONCLUSIONS: Higher heart rate, QT prolongation, and left ventricular hypertrophy on ECG have been determined to be associated with an increased risk of sudden death. Therefore, regular ECG recording could enable medical practitioners to identify hemodialysis patients who require intervention to prevent lethal arrhythmia.
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Hiyamuta et al. (2023) conducted a cohort in Maintenance hemodialysis (n=1,153). QTc prolongation vs. Normal QTc interval was evaluated on Sudden death (HR 2.10, 95% CI 1.30-3.77, p=0.01). QTc prolongation, higher heart rate, and left ventricular hypertrophy on ECG were independently associated with an approximately twofold increased risk of sudden death in hemodialysis patients.
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