Utility of P Wave Indices on Electrocardiography in Predicting the Left Atrial Volume Index in Chronic Kidney Disease Patients

INTRODUCTION: Left atrial volume (LAV) is a long-term marker for an array of physiological symptoms that can lead to high end-diastolic pressures - likening it to the echocardiographic equivalent of glycosylated hemoglobin (HbA1c). An increased left atrial volume index (LAVI) has been identified as an important biomarker for chronically increased LV diastolic pressure in chronic kidney disease (CKD) patients. We explored utilizing P wave parameters including newer parameters such as P wave peak time in predicting the increase in the LAVI in our study. MATERIAL AND METHODS: We included CKD patients (as per kidney disease: improving global outcomes (KIDGO)) with ages more than 18 years in our study from the nephrology department (OPD/IPD) at the Institute of Medical Sciences Banaras Hindu University (IMS-BHU), Varanasi, India. We excluded patients with rhythm abnormalities, decreased ejection fraction (<50%), valvular heart disease, coronary artery disease, and patients with poor echocardiographic assessment from our study. RESULTS: We enrolled 92 patients with CKD (as per KDIGO definition), out of which 72 met the inclusion-exclusion criteria. The study population's mean age was 53+/-11 years. Of the 72 individuals, 22 (30.6%) were females. Stage-wise depiction of CKD among the study population indicates that most patients (43, or 59.5%) were at stage 5. Thirty-six (50%) were on maintenance hemodialysis. Our analysis results indicate that the P wave peak time was the strongest predictor of the LAVI with a maximum area under the curve on the receiver operating characteristic (ROC) curve. CONCLUSION: Our study suggests that electrocardiographic (ECG) parameters such as p wave peak time can predict LAVI in CKD and ECG is an easily available tool; thus, this could help stratify cardiovascular risk, especially left ventricular diastolic dysfunction.