DOI: http://dx.doi.org/10.18203/2349-3933.ijam20211470

Electrocardiography in post hemodialysed chronic kidney disease patients

Jatin Soren, Chakradhar Majhi, Nayan K. Patel

Abstract


Background: Chronic kidney disease (CKD) is associated with higher risk of cardiovascular events and Electrocardiographic changes are common in CKD patients. Electrocardiography (ECG) is cheap and easily available investigation that could pick up abnormalities of heart. Our study focuses on electrocardiographic changes seen within 24 hours in post hemodialysis CKD patients.

Methods: It is a cross sectional, observational study of 298 CKD patients who underwent hemodialysis at tertiary care facility of VIMSAR, Burla during the period between November 2018 to November 2020. 12 leads ECG of these patients were taken post hemodialysis and abnormalities were interpreted.

Results: Total number of patients included in the study were 298 with mean age distribution of 47±8.4 years. Mean Serum urea level was 126 mg/dl. Creatinine levels ranged between 5-10 mg/dl. Left ventricular hypertrophy (LVH) and left atrial enlargement (LAE) were seen in 14.76% and 8.3% of patients respectively. Atrial fibrillation was present in 4.3% of patients. Left axis deviation (LAD 7%), right axis deviation (RAD 6%), atrial ectopics (2.6%) and tall T waves (7.3%) were the other ECG changes observed.

Conclusions: ECG changes are common in CKD patients in post hemodialysis state, so it becomes important to monitor these changes in these patients for early detection of any cardiac abnormalities.


Keywords


Chronic kidney disease, ECG, Hemodialysis, Left ventricular hypertrophy

Full Text:

PDF

References


Bargman JM, Skorecki KL. Harrison's Principles of Internal Medicine, 20th edition. 2013;2(2111-4).

Lisowska A, Musial WJ. Heart failure in the patients with chronic kidney disease. Roczniki Akademil Medycznej w Biaymlstoku. 2004;49.

Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney Disease as a Risk Factor for Development of Cardiovascular Disease: A Statement From the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension. 2003;108:2154-69.

Fisch C. Relation of electrolyte disturbances to cardiac arrhythmias. Circulation. 1973;47(2):408-19.

Parfrey PS, Vavasour HM, Henry S, Bullock M, Gault MH. Clinical features and severity of nonspecific symptoms in dialysis patients. Nephrone. 1988;50(2):121-8.

Karnik JA, Young BS, Lew NL, Herget M, Dubinsky C, Lazarus JM, Chertow GM. Cardiac arrest and sudden death in dialysis units. Kidney Int. 2001;60(1):350-7.

Shafi S, Saleem M, Anjum R, Abdullah W, Shafi T. ECG Abnormalities In Patients With Chronic Kidney Disease. J Ayub Med Coll Abbottabad. 2017;29(1):61-4.

Kestenbaum B, Rudser KD, Shlipak MG, Fried LF, Newman AB, Katz R, et al. Kidney function, electrocardiographic findings and cardiovascular events among older adults. Clin J Am Soc Nephrol. 2007;2(3):501-8.

Bignotto LH, Kallás ME, Djouki RJT, Sassaki MM, Voss GO, Soto CL, et al. Electrocardiographic findings in chronic haemodialysis patients. J Bras Nefrol. 2012;34(3):235-42.

Gansevoort RT, Mark PB, Rooney E, Mcdonagh TA, Dargie H, Stuart R, et al. Electrocardiographic abnormalities and ureamic cardiomyopathy. Kidney Int. 2005;67(1):217-26.

Dutta PK, Das S. Value of electrocardiogram in predialytic chronic kidney disease patients without known coronary artery disease. Int J Med Res Health Sci. 2014;3(4):967-74.

Stuart D, Pringle SD, Macfarlane PW, McKillop JH, Lorimer AR, Dunn FG. Pathophysiology association of left ventricular hypertrophy and straining asymptomatic patients with essential hypertension. J Am Coll Cardiol. 1989;13(6):1377-81.

Levy D, Kannel WB. Cardiovascular Risks; new insights from Framlingham. Am Heart J. 1988;116(1):266-72.

Goldstein BA, Arce CM, Hlatky MA, Turakhia M, Setoguchi S, Winkelmayer WC, et al. Trends in the incidence of atrial fibrillation in older patients initiating dialysis in United states. Circulation. 2012;126:2293-301.

Wetmore JB, Ellerbeck EF, Mahnken JD, Phadnis M, Rigler SK, Mukhopadhyay P, et al. Atrial fibrillation and risk of stroke in dialysis patients. Ann Epidemiol. 2013;23:112-8.

Winkelmayer WC, Patrick AR, Liu J, Brookhart MA, et al. Increasing prevalence of atrial fibrillation among haemodialysis patients. JASN. 2011;22(2):349-57.

Kuhn L, Rose L. ECG interpretation part 1: understanding mean electrical axis. J Emerg Nurs. 2008;34(6):530-4.