Associations of serum and dialysate electrolytes with QT interval and prolongation in incident hemodialysis: The Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study

Esther D. Kim, Jacqueline Watt, Larisa G. Tereshchenko, Bernard Jaar, Stephen M Sozio, W. H.Linda Kao, Michelle M. Estrella, Rulan S. Parekh

Research output: Contribution to journalArticle

Abstract

Background: Prolonged QT interval in hemodialysis patients may be associated with sudden cardiac death, however, few studies examined the longitudinal associations of modifiable factors such as serum and dialysate concentrations of calcium, potassium, and magnesium with corrected QT (QTc) prolongation in incident hemodialysis patients. Methods: In 330 in-center hemodialysis participants from the PACE study who were followed up for one year, we examined the associations of predialysis serum electrolytes (total calcium [Ca], corrected Ca [cCa], ionized Ca [iCa], potassium [K], magnesium [Mg]), dialysate (dCa and dK), and serum-to-dialysate gradient measures with QTc interval and prolongation (≥460 ms in women and ≥ 450 ms in men). Results: At the first study visit, 47% had QTc prolongation. Lower iCa and K were associated with longer QTc interval independent of potential confounders (QTc difference = 8.55[95% CI: 2.13, 14.97] ms for iCa; QTc difference = 9.89[1.58, 18.20] ms for K). Lower iCa was also associated with a higher risk of QTc prolongation. At 1 year of follow-up, 31% had persistent QTc prolongation. In longitudinal analyses, the associations of iCa and K with QTc interval remained significant, and lower K was associated with a higher risk of QTc prolongation while the association of iCa with QTc prolongation was borderline statistically significant. Serum Mg, dCa or dK, and respective gradients were not associated with QTc interval or prolongation. Conclusion: Prolonged QTc is very common in incident hemodialysis participants and persists over follow-up. Ionized Ca and K are consistently inversely associated with QTc prolongation, which suggests closer monitoring for a low calcium or potassium level to mitigate risk.

Original languageEnglish (US)
Article number133
JournalBMC nephrology
Volume20
Issue number1
DOIs
StatePublished - Apr 18 2019

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Dialysis Solutions
Electrolytes
Chronic Kidney Failure
Renal Dialysis
Calcium
Magnesium
Serum
Potassium
Sudden Cardiac Death
Longitudinal Studies

Keywords

  • Arrhythmia
  • Electrolytes
  • Hemodialysis
  • QT interval
  • QT prolongation

ASJC Scopus subject areas

  • Nephrology

Cite this

Associations of serum and dialysate electrolytes with QT interval and prolongation in incident hemodialysis : The Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study. / Kim, Esther D.; Watt, Jacqueline; Tereshchenko, Larisa G.; Jaar, Bernard; Sozio, Stephen M; Kao, W. H.Linda; Estrella, Michelle M.; Parekh, Rulan S.

In: BMC nephrology, Vol. 20, No. 1, 133, 18.04.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Prolonged QT interval in hemodialysis patients may be associated with sudden cardiac death, however, few studies examined the longitudinal associations of modifiable factors such as serum and dialysate concentrations of calcium, potassium, and magnesium with corrected QT (QTc) prolongation in incident hemodialysis patients. Methods: In 330 in-center hemodialysis participants from the PACE study who were followed up for one year, we examined the associations of predialysis serum electrolytes (total calcium [Ca], corrected Ca [cCa], ionized Ca [iCa], potassium [K], magnesium [Mg]), dialysate (dCa and dK), and serum-to-dialysate gradient measures with QTc interval and prolongation (≥460 ms in women and ≥ 450 ms in men). Results: At the first study visit, 47{\%} had QTc prolongation. Lower iCa and K were associated with longer QTc interval independent of potential confounders (QTc difference = 8.55[95{\%} CI: 2.13, 14.97] ms for iCa; QTc difference = 9.89[1.58, 18.20] ms for K). Lower iCa was also associated with a higher risk of QTc prolongation. At 1 year of follow-up, 31{\%} had persistent QTc prolongation. In longitudinal analyses, the associations of iCa and K with QTc interval remained significant, and lower K was associated with a higher risk of QTc prolongation while the association of iCa with QTc prolongation was borderline statistically significant. Serum Mg, dCa or dK, and respective gradients were not associated with QTc interval or prolongation. Conclusion: Prolonged QTc is very common in incident hemodialysis participants and persists over follow-up. Ionized Ca and K are consistently inversely associated with QTc prolongation, which suggests closer monitoring for a low calcium or potassium level to mitigate risk.",
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T2 - The Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study

AU - Kim, Esther D.

AU - Watt, Jacqueline

AU - Tereshchenko, Larisa G.

AU - Jaar, Bernard

AU - Sozio, Stephen M

AU - Kao, W. H.Linda

AU - Estrella, Michelle M.

AU - Parekh, Rulan S.

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AB - Background: Prolonged QT interval in hemodialysis patients may be associated with sudden cardiac death, however, few studies examined the longitudinal associations of modifiable factors such as serum and dialysate concentrations of calcium, potassium, and magnesium with corrected QT (QTc) prolongation in incident hemodialysis patients. Methods: In 330 in-center hemodialysis participants from the PACE study who were followed up for one year, we examined the associations of predialysis serum electrolytes (total calcium [Ca], corrected Ca [cCa], ionized Ca [iCa], potassium [K], magnesium [Mg]), dialysate (dCa and dK), and serum-to-dialysate gradient measures with QTc interval and prolongation (≥460 ms in women and ≥ 450 ms in men). Results: At the first study visit, 47% had QTc prolongation. Lower iCa and K were associated with longer QTc interval independent of potential confounders (QTc difference = 8.55[95% CI: 2.13, 14.97] ms for iCa; QTc difference = 9.89[1.58, 18.20] ms for K). Lower iCa was also associated with a higher risk of QTc prolongation. At 1 year of follow-up, 31% had persistent QTc prolongation. In longitudinal analyses, the associations of iCa and K with QTc interval remained significant, and lower K was associated with a higher risk of QTc prolongation while the association of iCa with QTc prolongation was borderline statistically significant. Serum Mg, dCa or dK, and respective gradients were not associated with QTc interval or prolongation. Conclusion: Prolonged QTc is very common in incident hemodialysis participants and persists over follow-up. Ionized Ca and K are consistently inversely associated with QTc prolongation, which suggests closer monitoring for a low calcium or potassium level to mitigate risk.

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KW - QT interval

KW - QT prolongation

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