Nocturnal Home Hemodialysis Associates with Improvement of Electrocardiographic Features Linked to Sudden Cardiac Death

Sudden cardiac death (SCD) remains the leading cause of death in hemodialysis patients. We performed a retrospective electrocardiograph (ECG) and chart review to determine whether hemodialysis modality, frequency, or duration could predict change in ECG parameters associated with SCD. Frequent nocturnal hemodialysis was associated with an improvement in Tpeak to Tend within 365 days (83.8-71.8 ms, p = 0.005) and past 365 days of dialysis initiation (85.9-77.1 ms, p = 0.005) and improvement in QRS amplitude variation within 365 days (0.0583-0.0297, p = 0.025) and past 365 days of dialysis initiation (0.0546-0.0332, p = 0.029). Compared with intermittent conventional hemodialysis, more frequent nocturnal (15/25 vs. 3/14, p = 0.04) and intermittent nocturnal hemodialysis (INHD) (6/8 vs. 3/14, p = 0.03) patients decreased Tpeak to Tend. More short-hours daily than INHD patients increased T-wave amplitude variation (16/25 vs. 1/8, p = 0.02). These improvements occurred before changes in Cornell or Sokolow-Lyon electrocardiographic left ventricular mass. Thus, it appears that hemodialysis modalities of longer duration are associated with improvements in electrocardiographic parameters associated with SCD. Prospective trials are required to determine whether dialysis prescription reduces SCD, cardiovascular morbidity, and mortality in hemodialysis patients.