Evaluation of the Relationship Between Electrocardiographic Changes and the Calcium/Potassium Ratio in Patients with Acute and Chronic Renal Failure

Abstract

The aim of this study was to investigate the relationship between serum calcium and potassium levels, as well as the calcium/potassium ratio, and electrocardiographic (ECG) changes in patients presenting to the emergency department with both renal failure and hyperkalemia. This cross-sectional study was conducted retrospectively by reviewing the medical records of patients diagnosed with renal failure and concomitant hyperkalemia (serum potassium>5.5 mEq/L) who presented to the emergency departments of a university hospital and a training and research hospital between November 1, 2022, and October 31, 2023. 55.4% of the patients were male, with a mean age of 68.31 ± 13.56 years. ECG abnormalities were detected in 69.5% of the cases. The most frequently observed ECG abnormalities were atrial fibrillation (22.0%) and peaked T waves (20.3%). Hemodialysis was performed in 52.5% of patients, 23.2% were admitted to the intensive care unit (ICU), and 15.8% died within 30 days of hospital presentation. Patients with T wave inversion had significantly lower potassium levels (6.42 ± 0.77 vs. 6.03 ± 0.71, p=0.018). In patients with any ECG abnormality, calcium levels (8.69 ± 0.87 vs. 8.36 ± 0.85, p=0.037) and calcium/potassium ratios (1.39 ± 0.19 vs. 1.32 ± 0.20, p=0.036) were significantly lower. The calcium/potassium ratio was also significantly lower in patients with peaked T waves (1.36 ± 0.20 vs. 1.27 ± 0.20, p=0.016). Among patients who died in-hospital or within 30 days, calcium/potassium ratios were significantly lower and potassium levels were significantly higher (p<0.05). In patients presenting to the emergency department with renal failure and concomitant hyperkalemia, the presence of ECG abnormalities was associated with lower calcium levels and a reduced calcium/potassium ratio. Moreover, 30-day mortality was found to be associated with higher potassium levels and a lower calcium/potassium ratio. These findings suggest that cardiac complications should be considered in clinical practice when hyperkalemia accompanies acute or chronic renal failure.

Keywords

• calcium
• potassium
• ECG
• emergency department

Akut ve Kronik Böbrek Yetmezliği olan Hastalarda Karşılaşılan EKG Değişikliklerinin Kalsiyum/ Potasyum Oranı ile İlişkisinin Değerlendirilmesi

Abstract

Çalışmanın amacı acil serviste böbrek yetmezliğine ek olarak hiperkalemi tespit edilen hastalarda kalsiyum, potasyum düzeyinin ve kalsiyum/potasyum oranının EKG değişiklikleri ile ilişkisini araştırmaktır. Kesitsel tipte olan bu çalışma, 1 Kasım 2022 – 31 Ekim 2023 tarihleri arasında bir üniversite hastanesi ve eğitim araştırma hastanesi acil servislerinde böbrek yetmezliği tanısına ek olarak hiperkalemi (>5,5 mEq/L) saptanan olguların dosyalarının retrospektif olarak değerlendirilmesi ile gerçekleştirilmiştir. Olguların %55,4’ü erkekti ve yaş ortalaması 68,31 ± 13,56 yıldı. Olguların %69,5’inin EKG’sinde en az bir patolojik değişiklik saptandı. En sık saptanan patolojik değişiklikler atrial fibrilasyon (%22,0) ve sivri T dalgasıydı (%20,3). Olguların %52,5’ine hemodiyaliz uygulandığı, %23,2’si YBÜ’ye yatırıldığı ve %15,8’inin hastane başvurusu sonrasındaki 30 gün içinde exitus olduğu saptandı. T dalgası inversiyonu saptananlarda potasyum düzeyi istatistiksel olarak anlamlı düzeyde daha düşüktü (6,42±0,77 vs 6,03±0,71, p=0,018). EKG’de herhangi bir patoloji saptananlarda kalsiyum (8,69±0,87 vs 8,36±0,85, p=0,037) ve kalsiyum/potasyum oranı istatistiksel olarak anlamlı düzeyde daha düşük saptandı (1,39±0,19 vs 1,32±0,2, p=0,036). Sivri T dalgası saptananlarda kalsiyum/ potasyum oranı istatistiksel olarak anlamlı düzeyde daha düşüktü (1,36±0,2 vs 1,27±0,2, p=0,016). Hastanede veya 30 gün içinde ölen olguların kalsiyum/ potasyum düzeyi istatistiksel olarak anlamlı düzeyde daha düşük, potasyum düzeyi ise daha yüksekti (p<0,05). Sonuç olarak, acil servise böbrek yetmezliği tanısına ek olarak hiperkalemi ile başvuran olgularda EKG’de patoloji saptanma durumu daha düşük kalsiyum düzeyi ve kalsiyum/potasyum oranı ile ilişkilendirilmiştir. Ayrıca ilk 30 gün içinde mortalite, potasyum düzeyinin artışı ve kalsiyum/potasyum oranının azalışı ile ilişkili bulunmuştur. Rutin pratikte akut ya da kronik böbrek yetmezliğine ek olarak hiperkalemi saptanan olgularda kliniğe kardiyak sorunların eşlik edebileceği akılda tutulmalıdır.

Keywords

• kalsiyum
• potasyum
• EKG
• acil servis

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