(Kahramanmaraş Sütçü İmam Üniversitesi)
(Kahramanmaraş Sütçü İmam Üniversitesi)
Yusuf Selçuk YILDIZ
(Kahramanmaraş Sütçü İmam Üniversitesi)
(Kocatepe Üniversitesi)
Fatma Betül GÜZEL
(Kahramanmaraş Sütçü İmam Üniversitesi)
(Kahramanmaraş Sütçü İmam Üniversitesi)
(Kahramanmaraş Sütçü İmam Üniversitesi)
(Kahramanmaraş Sütçü İmam Üniversitesi)
(Kahramanmaraş Sütçü İmam Üniversitesi)
Yıl: 2018Cilt: 27Sayı: 2ISSN: 1300-7718Sayfa Aralığı: 189 - 195İngilizce

72 1
Evaluation of Cardiac Repolarization and Serum Electrolytes in Pre-Dialytic Stages of Chronic Kidney Disease
OBJECTIVE: Patients with chronic kidney disease (CKD) have increased risk for cardiac arrhythmias. Other than comorbidities like diabetes mellitus and cardiovascular disease, factors like acidosis, uremia and electrolyte imbalance may contribute to this risk. The aim of this study was to evaluate electrocardiography (ECG) measurements of ventricular repolarization and search for related clinical features like serum electrolytes that may indicate a risk for arrhythmias in patients with pre-dialytic CKD. MATERIAL and METHODS: The study included 107 patients with stage 3-5 CKD and 49 healthy individuals. ECG parameters; QT, QTc, Tp-e, Tp-e/QT and Tp-e/QTc were measured on ECG recordings from all participants. Clinical features and serum electrolyte values were recorded. RESULTS: Mean QTc of patients were higher than healthy controls (p=0.008). We found positive correlations with QTc measurements and serum magnesium and phosphorus levels. We demonstrated that Tp-e, Tp-e/QT and Tp-e/QTc were negatively correlated with potassium levels (p=0.023, 0.042, 0.013). Regression for clinical features revealed no other relation for these correlations. CONCLUSION: Measuring ECG parameters may help to identify additional risk factors for arrhythmogenesis. We found increased QTc measurements in pre-dialytic CKD patients who were younger than in previous studies. Tp-e, Tp-e/QT and Tp-e/QTc were negatively correlated with serum potassium. Electrolyte imbalances like hypokalemia might unravel the susceptibility for arrhythmias in CKD patients.
Fen > Tıp > Cerrahi
DergiAraştırma MakalesiErişime Açık
  • 1. Herzog CA, Asinger RW, Berger AK, Charytan DM, Díez J, Hart RG, Eckardt KU, Kasiske BL, McCullough PA, Passman RS, DeLoach SS, Pun PH, Ritz E: Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2011;80(6):572-586
  • 2. Alsheikh-Ali AA, Trikalinos TA, Ruthazer R, Terrin N, Wong JB, Sarnak MJ, Estes NA 3rd, Kent DM: Risk of arrhythmic and nonarrhythmic death in patients with heart failure and chronic kidney disease. Am Heart J 2011;161(1): 204-209
  • 3. Di Lullo L, Rivera R, Barbera V, Bellasi A, Cozzolino M, Russo D, De Pascalis A, Banerjee D, Floccari F, Ronco C: Sudden cardiac death and chronic kidney disease: From pathophysiology to treatment strategies. Int J Cardiol 2016;217:16-27
  • 4. Di Iorio B, Bellasi A: QT interval in CKD and haemodialysis patients. Clin Kidney J 2013;6(2):137-143
  • 5. Monfared A, Assadian Rad M, Feizkhah M, Kazemnezhad E, Esmaeili S, Rastjou Herfeh N, Hedayatsafa R: Comparison of tpe changing on ECG, in pre and post dialysis and post transplantation. Nephrourol Mon 2016;8(3):e35864
  • 6. Hansen S, Rasmussen V, Torp-Pedersen C, et al: QT intervals and QT dispersion determined from a 12-lead 24-hour Holter recording in patients with coronary artery disease and patients with heart failure. Ann Noninvasive Electrocardiol 2008;13:22-30
  • 7. Topilski I, Rogowski O, Rosso R, Justo D, Copperman Y, Glikson M: The morphology of the QT interval predicts torsade de pointes during acquired bradyarrhythmias. J Am Coll Cardiol 2007;49:320- 328
  • 8. Levey AS, Coresh J, Greene T, et al: Chronic kidney disease epidemiology collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145:247-254
  • 9. Montanez A, Ruskin JN, Hebert PR, et al: Prolonged QTc interval and risks of total and cardiovascular mortality and sudden death in the general population: A review and qualitative overview of the prospective cohort studies. Arch Intern Med 2004;164: 943-948
  • 10. Kors JA, Ritsema van Eck HJ, van Herpen G: The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol 2008; 41:575-580
  • 11. Watanabe N, Kobayashi Y, Tanno K, et al: Transmural dispersion of repolarization and ventricular tachyarrhythmias. J Electrocardiol 2004;37:191-200
  • 12. Opthof T, Coronel R, Wilms-Schopman FJ, Plotnikov AN, Shlapakova IN, Danilo P Jr, Rosen MR, Janse MJ: Dispersion of repolarization in canine ventricle and the electrocardiographic T wave: Tp-e interval does not reflect transmural dispersion. Heart Rhythm 2007;4(3):341-348
  • 13. Opthof T, Janse MJ, Meijborg VM, Cinca J, Rosen MR, Coronel R: Dispersion in ventricular repolarization in the human, canine and porcine heart. Prog Biophys Mol Biol 2016;120(1-3):222-235
  • 14. Haarmark C, Hansen PR, Vedel-Larsen E, Pedersen SH, Graff C, Andersen MP, et al: The prognostic value of the Tpeak-Tend interval in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Electrocardiol 2009;42:555-560
  • 15. Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R, et al: Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol 2011;4:441-447
  • 16. Tokatli A, Kiliçaslan F, Alis M, Yiginer O, Uzun M: Prolonged Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in patients with type 2 diabetes mellitus. Endocrinol Metab (Seoul) 2016;31(1):105-112
  • 17. Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT, Yan GX: T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008;41(6):567-574
  • 18. Castro-Torres Y, Carmona-Puerta R, Katholi RE: Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice. World J Clin Cases 2015;3(8):705-720
  • 19. Deo R, Shou H, Soliman EZ, Yang W, Arkin JM, Zhang X, Townsend RR, Go AS, Shlipak MG, Feldman HI: Electrocardiographic measures and prediction of cardiovascular and noncardiovascular death in CKD. J Am Soc Nephrol 2016; 27(2):559-569
  • 20. Kestenbaum B, Rudser KD, Shlipak MG, Fried LF, Newman AB, Katz R, Sarnak MJ, Seliger S, Stehman-Breen C, Prineas R, Siscovick DS: Kidney function, electrocardiographic findings, and cardiovascular events among older adults. Clin J Am Soc Nephrol 2007;2(3):501-508
  • 21. Dobre M, Brateanu A, Rashidi A, Rahman M: Electrocardiogram abnormalities and cardiovascular mortality in elderly patients with CKD. Clin J Am Soc Nephrol 2012;7(6):949-956
  • 22. Hage FG, de Mattos AM, Khamash H, Mehta S, Warnock D, Iskandrian AE: QT prolongation is an independent predictor of mortality in end-stage renal disease. Clin Cardiol 2010;33:361-366
  • 23. Musso CG: Magnesium metabolism in health and disease. Int Urol Nephrol 2009;41(2):357-362
  • 24. Sakaguchi Y, Hamano T, Nakano C, Obi Y, Matsui I, Kusunoki Y, Mori D, Oka T, Hashimoto N, Takabatake Y, Takahashi A, Kaimori JY, Moriyama T, Yamamoto R, Horio M, Sugimoto K, Yamamoto K, Rakugi H, Isaka Y: Association between density of coronary artery calcification and serum magnesium levels among patients with chronic kidney disease. PLoS One 2016;11(9):e0163673
  • 25. Jhang WK, MD, Lee YJ, Kim YA, MD, Park SJ, Park YS: Severe hypermagnesemia presenting with abnormal electrocardiographic findings similar to those of hyperkalemia in a child undergoing peritoneal dialysis. Korean J Pediatr 2013;56(7):308-311
  • 26. Claes KJ, Heye S, Nuyens D, Bammens B, Kuypers DR, Vanrenterghem Y, Evenepoel P: Impact of vascular calcification on corrected QT interval at the time of renal transplantation. Am J Nephrol 2012;35: 24-30
  • 27. Sherif KA, Abo-Salem E, Panikkath R, Nusrat M, Tuncel M: Cardiac repolarization abnormalities among patients with various stages of chronic kidney disease. Clin Cardiol 2014; 37:417-421
  • 28. Scherr J, Schuster T, Pressler A, Roeh A, Christle J, Wolfarth B, Halle M: Repolarization perturbation and hypomagnesemia after extreme exercise. Med Sci Sports Exerc 2012; 44(9):1637-1643
  • 29. Severi S, Grandi E, Pes C, Badiali F, Grandi F, Santoro A: Calcium and potassium changes during haemodialysis alter ventricular repolarization duration: In vivo and in silico analysis. Nephrol Dial Transplant 2008; 23:1378-1386
  • 30. Di Iorio B, Torraca S, Piscopo C, Sirico ML, Di Micco L, Pota A, Tartaglia D, Berardino L, Morrone LF, Russo D: Dialysate bath and QTc interval in patients on chronic maintenance hemodialysis: Pilot study of single dialysis effects. J Nephrol 2012;25:653-660
  • 31. Kalantzi K, Gouva C, Letsas KP, Vlachopanou A, Foulidis V, Bechlioulis A, Katopodis KP, Goudevenos CA, Korantzopoulos P: The impact of hemodialysis on the dispersion of ventricular repolarization. Pace 2013;36:3:322-327
  • 32. Guclu A, Sipahioglu MH, Icli A, Alpay MF, Narman S: Tp-e/QT and Tp-e/QTc ratio in hemodialysis and peritoneal dialysis patients. Turk Neph Dial Transpl 2016;25(3):273-278
  • 33. Mozos I: Laboratory markers of ventricular arrhythmia risk in renal failure. Biomed Res Int 2014;2014:509204
  • 34. Priest BT, McDermott JS: Cardiac ion channels. Channels (Austin). 2015;9(6):352-359
  • 35. Foglia PE, Bettinelli A, Tosetto C, Cortesi C, Crosazzo L, Edefonti A, Bianchetti MG: Cardiac work up in primary renal hypokalaemiahypomagnesemia (Gitelman syndrome). Nephrol Dial Transplant 2004;19(6):1398-1402

TÜBİTAK ULAKBİM Ulusal Akademik Ağ ve Bilgi Merkezi Cahit Arf Bilgi Merkezi © 2019 Tüm Hakları Saklıdır.