Key result
Sudden cardiac death in hemodialysis patients was associated with longer pre-hemodialysis QRS duration (100.6 vs 92.6 ms, p=0.015) and longer QTpe intervals (p<0.001) compared to survivors.
Why the study?
Patients undergoing hemodialysis have a significantly higher rate of sudden cardiac death than the general population and carry the highest risk for arrhythmogenic death.
Do serial electrocardiography measurements (QT peak-to-end interval and QRS duration) before and after hemodialysis predict sudden cardiac death in patients with end-stage renal disease?
Observational (n=678)
Yes
Do serial electrocardiography measurements (QT peak-to-end interval and QRS duration) before and after hemodialysis predict sudden cardiac death in patients with end-stage renal disease?
p-value: p=<0.001
Longer QT peak-to-end intervals before hemodialysis and large changes in ECG parameters after hemodialysis are associated with a higher risk of sudden cardiac death in end-stage renal disease patients.
May support ECG-based risk stratification in hemodialysis; hypothesis-generating and requires prospective validation before clinical use.
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.
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Lee et al. (2021) conducted an observational in End-Stage Renal Disease Undergoing Hemodialysis (n=678). Serial electrocardiography measurements (QTpe interval and QRS duration) vs. Survivors was evaluated on Sudden cardiac death (SCD) (p=<0.001). Sudden cardiac death in hemodialysis patients was associated with longer pre-hemodialysis QRS duration (100.6 vs 92.6 ms, p=0.015) and longer QTpe intervals (p<0.001) compared to survivors.
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