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Associations of serum and dialysate electrolytes with QT interval and prolongation in incident hemodialysis: the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study.
Kim, Esther D; Watt, Jacqueline; Tereshchenko, Larisa G; Jaar, Bernard G; Sozio, Stephen M; Kao, W H Linda; Estrella, Michelle M; Parekh, Rulan S.
Afiliación
  • Kim ED; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Watt J; Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA.
  • Tereshchenko LG; Child Health Evaluative Sciences, The Hospital for Sick Children, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
  • Jaar BG; Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA.
  • Sozio SM; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Kao WHL; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Estrella MM; Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA.
  • Parekh RS; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
BMC Nephrol ; 20(1): 133, 2019 04 18.
Article en En | MEDLINE | ID: mdl-30999887
BACKGROUND: Prolonged QT interval in hemodialysis patients may be associated with sudden cardiac death, however, few studies examined the longitudinal associations of modifiable factors such as serum and dialysate concentrations of calcium, potassium, and magnesium with corrected QT (QTc) prolongation in incident hemodialysis patients. METHODS: In 330 in-center hemodialysis participants from the PACE study who were followed up for one year, we examined the associations of predialysis serum electrolytes (total calcium [Ca], corrected Ca [cCa], ionized Ca [iCa], potassium [K], magnesium [Mg]), dialysate (dCa and dK), and serum-to-dialysate gradient measures with QTc interval and prolongation (≥460 ms in women and ≥ 450 ms in men). RESULTS: At the first study visit, 47% had QTc prolongation. Lower iCa and K were associated with longer QTc interval independent of potential confounders (QTc difference = 8.55[95% CI: 2.13, 14.97] ms for iCa; QTc difference = 9.89[1.58, 18.20] ms for K). Lower iCa was also associated with a higher risk of QTc prolongation. At 1 year of follow-up, 31% had persistent QTc prolongation. In longitudinal analyses, the associations of iCa and K with QTc interval remained significant, and lower K was associated with a higher risk of QTc prolongation while the association of iCa with QTc prolongation was borderline statistically significant. Serum Mg, dCa or dK, and respective gradients were not associated with QTc interval or prolongation. CONCLUSION: Prolonged QTc is very common in incident hemodialysis participants and persists over follow-up. Ionized Ca and K are consistently inversely associated with QTc prolongation, which suggests closer monitoring for a low calcium or potassium level to mitigate risk.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Síndrome de QT Prolongado / Enfermedades Cardiovasculares / Diálisis Renal / Muerte Súbita Cardíaca / Electrólitos / Hipocalcemia / Hipopotasemia / Fallo Renal Crónico Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: BMC Nephrol Asunto de la revista: NEFROLOGIA Año: 2019 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Síndrome de QT Prolongado / Enfermedades Cardiovasculares / Diálisis Renal / Muerte Súbita Cardíaca / Electrólitos / Hipocalcemia / Hipopotasemia / Fallo Renal Crónico Tipo de estudio: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: BMC Nephrol Asunto de la revista: NEFROLOGIA Año: 2019 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido