HEMODİYALİZ HASTALARINDA DİYALİZ ÖNCESİ VE SONRASI ELEKTROKARDİYOGRAFİ İLE ELEKTROLİTLER ARASI İLİŞKİ

Year 2024, , 204 - 209, 31.07.2024

Semahat Karahisar Şirali

https://doi.org/10.16899/jcm.1502013

Abstract

Bacground: Hemodiyaliz hastalarında kardiyovasküler olaylar en önemli mortalite nedenidir. Diyaliz esnasındaki hızlı volüm değişiklikleri ve elektrolit şiftleri aritmilere önderlik eder.
Objective: Diyaliz hastalarında hemodiyaliz öncesi ve sonrası elektrokardiyografik (ECG) dalga ve interval değişiklikleri ile elektrolit düzeyleri arasında ilişki olup olmadığını belirlemeyi amaçladık.
Metods: Altı aydan uzun süredir haftada üç kez dört saat hemodiyalize giren 112 hasta çalışmaya alındı. Hemodiyaliz öncesi ve sonrası 12-derivasyonlu EKG, kilo, tansiyon arteriyel, hemogram, biyokimya ve demografik verileri kaydedildi. Diyaliz öncesi ve hemen sonrası çekilen 12-derivasyonlu EKG’den dalga ve intervalleri hesaplanarak serum elektrolit düzeyleri ile arasındaki ilişki değerlendirildi. P<.05 anlamlı kabul edildi.
Results: Hastaların %51.8 kadın, ortalama yaş 49.83(±18.69) idi. Diyaliz sonrası RR intervalinin, fosfor ile negatif yönde (p=.007), ürik asit ile negatif yönde (p=.013) korelasyonu bulundu.
Öncesi QTc ile ürik asit negatif yönde (p=.008) orta derecede, sonrası QTc ile sodyum negatif yönde (p=.016) orta derecede korelasyonu bulundu. Lineer regresyon analizinde sonrası RR üzerinde fosfor (p=.007) ve ürik asit (p=.013) anlamlı, öncesi QTc üzerinde ürik asit (p=.008) anlamlı, sonrası QTc üzerinde sodyum (p=.016) ve kalsiyum (p=.027) anlamlı bulundu.
Conclusion: Diyaliz sonrası RR intervali ile fosfor ve ürik asit arasında negatif yönde, öncesi QTc ile ürik asit arasında ve sonrası QTc ile sodyum arasında negatif yönde bulunan korelasyon, volüm ve elektrolit şiftleri sonucu EKG yorumunu ve aritmi risk değerlendirmesini zorlaştırmaktadır.

Keywords

Hemodialysis, electrocardiography, electrolytes

RELATIONSHIP BETWEEN ELECTROCARDIOGRAPHY AND ELECTROLYTES BEFORE AND AFTER DIALYSIS IN HEMODIALYSIS PATIENTS

Abstract

Background: Cardiovascular events are the most important cause of mortality in hemodialysis patients. Rapid volume changes and electrolyte shifts during dialysis lead to arrhythmias.
Objective: We aimed to determine whether there is a relationship between electrocardiographic (ECG) wave and interval changes and electrolyte levels before and after hemodialysis in dialysis patients.
Materials and Method: A total of 112 patients undergoing hemodialysis three times a week for four hours for more than six months were included in the study. Before and after hemodialysis, 12-lead ECG, weight, arterial blood pressure, hemogram, biochemistry, and demographic data were recorded. Waves and intervals were calculated from the 12-lead ECG taken before and immediately after dialysis, and the relationship with serum electrolyte levels was evaluated. P<.05 was considered significant.
Results: Among the patients, 51.8% were female, and the mean age was 49.83(±18.69) years. Post-dialysis RR interval correlated negatively with phosphorus (p=.007) and negatively with uric acid (p=.013).
Pre-QTc correlated negatively (p=.008) moderately with uric acid and negatively (p=.016) moderately with sodium. In linear regression analysis, phosphorus (p=.007) and uric acid (p=.013) were significant on post-RR, uric acid (p=.008) was significant on pre-QTc, sodium (p=.016) and calcium (p=.027) were significant on post-QTc.
Conclusion: The negative correlation between post-dialysis RR interval and phosphorus and uric acid, between pre-dialysis QTc and uric acid, and between post-dialysis QTc and sodium makes ECG interpretation and arrhythmia risk assessment difficult as a result of volume and electrolyte shifts.

Keywords

: Hemodialysis, electrocardiography, electrolytes

Ethical Statement

It was conducted with the decision of Mardin Artuklu University non-invasive clinical research ethics committee dated May-3.2023 and numbered 2023/5-10.

Supporting Institution

None

Thanks

I would like to thank the Mardin dialysis team and my teacher, Prof. Dr. Mehmet Fatih Bulucu, for reading my article.

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