Research Article
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Comparison of pathological electrocardiographic changes between long-term kidney transplant recipients and hemodialysis patients

Year 2024, Volume: 7 Issue: 5, 513 - 517, 27.09.2024
https://doi.org/10.32322/jhsm.1519695

Abstract

Aims: We aimed to reveal electrocardiographic changes in kidney transplant recipients (KTRs) compared with hemodialysis patients.
Methods: We included 70 KTRs who had underwent a kidney transplantation for more than one year and 84 patients who had been on hemodialysis for more than one year. We recorded age, sex, body-mass index (BMI) (kg/m2), primary disease (makes chronic kidney disease) and duration of hemodialysis treatment. Standard measurements such as heart rate (HR), P wave, PR interval, P axis, QRS complex, QRS axis, T axis, QT interval and QTc interval were performed for all electrocardiography (ECG).
Results: KTRs were younger than the hemodialysis patients group (HPG) (31.5 vs. 54.5, p<0.001). The female gender was more common in the HPG (54.8% vs. 28.6%, p=0.001). Diabetes mellitus (DM) and hypertension (HT) were more common in the HPG (21.4% vs. 7.1% and 47.6% vs. 15.7% respectively, p<0.001). There was no statistically significant difference between KTRs and HPG in terms of heart rate, P axis, P-wave, QRS axis, QRS complex, RR interval, while T axis was higher in HPG (65o vs. 40.5o, p=0.001), PR interval was longer in HPG (152 msec vs 144 msec, p=0.020), QT interval was longer in HPG (385 msec vs 360 msec, p<0.001), QTc was longer in HPG (463 msec vs 415.5 msec, p<0.001).
Conclusion: In the long term after kidney transplantation, improvement of ECG pathologies such as prolonged QT and abnormal T axis seen in HPG may be the result of an improved uremic milieu and reduced inflammation in KTRs.

Ethical Statement

The study was retrospective, single-center, and approved by the Clinical Research Ethics Committee of Health Science Of University Gazi Yaşargil Training and Research Hospital (Decision Date and Number: 19.09.2023/524). It was performed as per the principles of the Declaration of Helsinki.

Supporting Institution

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Project Number

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References

  • Johansen KL, Chertow GM, Gilbertson DT, et al. US Renal Data System 2021 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2022;79(4 Suppl 1):A8-A12.
  • Ortiz A, Covic A, Fliser D, et al. Epidemiology, contributors to, and clinical trials of mortality risk in chronic kidney failure. Lancet. 2014;383(9931):1831-1843.
  • Genovesi S, Boriani G, Covic A, et al. EUDIAL working group of ERA-EDTA. Sudden cardiac death in dialysis patients: different causes and management strategies. Nephrol Dial Transplant. 2021;36(3):396-405.
  • Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2019;73(3 Suppl 1):A7-A8.
  • Wilson GJ, Van K, O’Lone E, et al. Range and consistency of cardiovascular outcomes reported by clinical trials in kidney transplant recipients: a systematic review. Transplant Direct. 2022;9(1):e1398.
  • Di Iorio B, Bellasi A. QT interval in CKD and haemodialysis patients. Clin Kidney J. 2013;6(2):137-1343.
  • Goldberger AL, Goldberger ZD, Shvilkin A. Goldberger’s Clinical Electrocardiography a Simplified Approach 8th ed. Elsevier Saunders, 2013.
  • Salles GF, Xavier SS, Sousa AS, Hasslocher-Moreno A, Cardoso CR. T-wave axis deviation as an independent predictor of mortality in chronic Chagas’ disease. Am J Cardiol. 2004;93(9): 1136-1140.
  • Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular disease in chronic kidney disease: pathophysiological insights and therapeutic options. Circulation. 2021;143(11):1157-1172.
  • Boriani G, Savelieva I, Dan GA, et al. Chronic kidney disease in patients with cardiac rhythm disturbances or implantable electrical devices: clinical significance and implications for decision making-a position paper of the European Heart Rhythm Association endorsed by the Heart Rhythm Society and the Asia Pacific Heart Rhythm Society. Europace. 2015;17(8):1169-1196.
  • Xu C, Tsihlis G, Chau K, Trinh K, Rogers NM, Julovi SM. Novel perspectives in chronic kidney disease-specific cardiovascular disease. Int J Mol Sci. 2024;25(5):2658.
  • Akcay M, Yıldırım U. Effect of dialysis and transplantation on myocardial repolarization parameters and P-wave dispersion in chronic kidney disease. J Arrhythm. 2021;37(2):348-355.
  • Genovesi S, Rossi E, Nava M, et al. A case series of chronic haemodialysis patients: mortality, sudden death, and QT interval. Europace. 2013;15(7):1025-1033.
  • Sherif KA, Abo-Salem E, Panikkath R, et al. Cardiac repolarization abnormalities among patients with various stages of chronic kidney disease. Clin Cardiol. 2014;37(7):417-421.
  • Oktavia D, Nasution SA, Setiati S. The clinical factors’prediction of increased intradialytic QT dispersion on the electrocardiograms of chronic hemodialysis patients. Saudi J Kidney Dis Transpl. 2013;24(2):274-280.
  • Hage FG, de Mattos AM, Khamash H, et al. QT prolongation is an independent predictor of mortality in end-stage renal disease. Clin Cardiol. 2010;33(6):361-366.
  • Beaubien ER, Pylypchuk GB, Akhtar J, et al. Value of corrected QT interval dispersion in identifying patients initiating dialysis at increased risk of total and cardiovascular mortality. Am J Kidney Dis. 2002;39(4):834-842.
  • Monfared A, Ghods AJ. Improvement of maximum corrected QT and corrected QT dispersion in electrocardiography after kidney transplantation. Iran J Kidney Dis. 2008;2(2):95-98.
  • Monfared A, Atrkar Roshan Z, Salari A, et al. QT intervals in patients receiving a renal transplant. Exp Clin Transplant. 2012; 10(2):105-109.
  • Durak MI, Algul Durak B. The comparison of QTc dispersion between renal transplant recipients and healthy individuals. Cureus. 2022;14(12):e32458.
  • Liu P, Wang L, Han D, Sun C, Xue X, Li G. Acquired long QT syndrome in chronic kidney disease patients. Ren Fail. 2020; 42(1):54-65.
  • Robison LB, Brady WJ, Robison RA, Charlton N. QT interval prolongation and the risk of malignant ventricular dysrhythmia and/or cardiac arrest: Systematic search and narrative review of risk related to the magnitude of QT interval length. Am J Emerg Med. 2021;49:40-47.
  • Scherer ML, Aspelund T, Sigurdsson S, et al. Abnormal T-wave axis is associated with coronary artery calcification in older adults. Scand Cardiovasc J. 2009;43(4):240-248.
Year 2024, Volume: 7 Issue: 5, 513 - 517, 27.09.2024
https://doi.org/10.32322/jhsm.1519695

Abstract

Project Number

no

References

  • Johansen KL, Chertow GM, Gilbertson DT, et al. US Renal Data System 2021 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2022;79(4 Suppl 1):A8-A12.
  • Ortiz A, Covic A, Fliser D, et al. Epidemiology, contributors to, and clinical trials of mortality risk in chronic kidney failure. Lancet. 2014;383(9931):1831-1843.
  • Genovesi S, Boriani G, Covic A, et al. EUDIAL working group of ERA-EDTA. Sudden cardiac death in dialysis patients: different causes and management strategies. Nephrol Dial Transplant. 2021;36(3):396-405.
  • Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2019;73(3 Suppl 1):A7-A8.
  • Wilson GJ, Van K, O’Lone E, et al. Range and consistency of cardiovascular outcomes reported by clinical trials in kidney transplant recipients: a systematic review. Transplant Direct. 2022;9(1):e1398.
  • Di Iorio B, Bellasi A. QT interval in CKD and haemodialysis patients. Clin Kidney J. 2013;6(2):137-1343.
  • Goldberger AL, Goldberger ZD, Shvilkin A. Goldberger’s Clinical Electrocardiography a Simplified Approach 8th ed. Elsevier Saunders, 2013.
  • Salles GF, Xavier SS, Sousa AS, Hasslocher-Moreno A, Cardoso CR. T-wave axis deviation as an independent predictor of mortality in chronic Chagas’ disease. Am J Cardiol. 2004;93(9): 1136-1140.
  • Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular disease in chronic kidney disease: pathophysiological insights and therapeutic options. Circulation. 2021;143(11):1157-1172.
  • Boriani G, Savelieva I, Dan GA, et al. Chronic kidney disease in patients with cardiac rhythm disturbances or implantable electrical devices: clinical significance and implications for decision making-a position paper of the European Heart Rhythm Association endorsed by the Heart Rhythm Society and the Asia Pacific Heart Rhythm Society. Europace. 2015;17(8):1169-1196.
  • Xu C, Tsihlis G, Chau K, Trinh K, Rogers NM, Julovi SM. Novel perspectives in chronic kidney disease-specific cardiovascular disease. Int J Mol Sci. 2024;25(5):2658.
  • Akcay M, Yıldırım U. Effect of dialysis and transplantation on myocardial repolarization parameters and P-wave dispersion in chronic kidney disease. J Arrhythm. 2021;37(2):348-355.
  • Genovesi S, Rossi E, Nava M, et al. A case series of chronic haemodialysis patients: mortality, sudden death, and QT interval. Europace. 2013;15(7):1025-1033.
  • Sherif KA, Abo-Salem E, Panikkath R, et al. Cardiac repolarization abnormalities among patients with various stages of chronic kidney disease. Clin Cardiol. 2014;37(7):417-421.
  • Oktavia D, Nasution SA, Setiati S. The clinical factors’prediction of increased intradialytic QT dispersion on the electrocardiograms of chronic hemodialysis patients. Saudi J Kidney Dis Transpl. 2013;24(2):274-280.
  • Hage FG, de Mattos AM, Khamash H, et al. QT prolongation is an independent predictor of mortality in end-stage renal disease. Clin Cardiol. 2010;33(6):361-366.
  • Beaubien ER, Pylypchuk GB, Akhtar J, et al. Value of corrected QT interval dispersion in identifying patients initiating dialysis at increased risk of total and cardiovascular mortality. Am J Kidney Dis. 2002;39(4):834-842.
  • Monfared A, Ghods AJ. Improvement of maximum corrected QT and corrected QT dispersion in electrocardiography after kidney transplantation. Iran J Kidney Dis. 2008;2(2):95-98.
  • Monfared A, Atrkar Roshan Z, Salari A, et al. QT intervals in patients receiving a renal transplant. Exp Clin Transplant. 2012; 10(2):105-109.
  • Durak MI, Algul Durak B. The comparison of QTc dispersion between renal transplant recipients and healthy individuals. Cureus. 2022;14(12):e32458.
  • Liu P, Wang L, Han D, Sun C, Xue X, Li G. Acquired long QT syndrome in chronic kidney disease patients. Ren Fail. 2020; 42(1):54-65.
  • Robison LB, Brady WJ, Robison RA, Charlton N. QT interval prolongation and the risk of malignant ventricular dysrhythmia and/or cardiac arrest: Systematic search and narrative review of risk related to the magnitude of QT interval length. Am J Emerg Med. 2021;49:40-47.
  • Scherer ML, Aspelund T, Sigurdsson S, et al. Abnormal T-wave axis is associated with coronary artery calcification in older adults. Scand Cardiovasc J. 2009;43(4):240-248.
There are 23 citations in total.

Details

Primary Language English
Subjects Cardiology
Journal Section Original Article
Authors

Süleyman Akkaya 0000-0003-3214-4837

Ümit Çakmak 0000-0003-0155-5633

Project Number no
Publication Date September 27, 2024
Submission Date July 20, 2024
Acceptance Date August 16, 2024
Published in Issue Year 2024 Volume: 7 Issue: 5

Cite

AMA Akkaya S, Çakmak Ü. Comparison of pathological electrocardiographic changes between long-term kidney transplant recipients and hemodialysis patients. J Health Sci Med / JHSM. September 2024;7(5):513-517. doi:10.32322/jhsm.1519695

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