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

Year 2025, Volume: 51 Issue: 2, 285 - 290, 28.08.2025

Qatada Omar Mohammad Aldabbas , Ozlem Koksal , Melih Yüksel , Enad Kenan , Vahide Aslıhan Durak , Göksel Aydoğan

https://doi.org/10.32708/uutfd.1701404

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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