Long QT, alteration of calcium-phosphate product, prevalence of ventricular arrhythmias and sudden death in peritoneal dialysis patients: a Holter study

Materials and methods We studied 79 patients on peritoneal dialysis. Each underwent 24-h electrocardiography (Holter monitoring) and measurement of the rate-corrected QT interval (QTc). We analyzed the correlation between QTc and plasma levels of Ca++, PO4−, K+, Na+, Mg++, and parathyroid hormone (PTH). Results The mean QTc was 0.445 ± 0.04 s. In 55 patients, the QTc was prolonged (> 0.45 s). Mean laboratory values for the group were: PTH 344 ± 25 pg/mL, Ca++ 9.27 ± 0.11 mg/dL, PO4− 5.5 ± 1.5 mg/dL, Na+ 139.6 ± 3.4 mmol/L, K+ 4.04 ± 0.64 mmol/L, and Mg++ 2.52 ± 0.43 mg/dL. Holter monitoring revealed complex premature ventricular contractions in 44 patients, monomorphic premature ventricular contractions in 16, and nonsustained ventricular tachycardia (NSVT) in 10. The QTc was significantly correlated with plasma levels of PO4− (r = 0.045, p < 0.05), PTH (r = 0.077, p < 0.02), and Ca++ (r = 0.076, p < 0.02). Eleven patients had Lown class 4a or 4b ventricular arrhythmias, and their mean QTc was 465 ± 0.02 ms. Ten had NSVT and their QTc was 464 ± 0.03 ms. Eleven patients died suddenly (mean QTc 465 ± 0.03 ms); all 11 had either NSTV or Lown class 4 ventricular arrhythmias. Conclusions Long QTc seems to be associated with an increased prevalence of ventricular arrhythmias that may be the cause of sudden cardiac death.

Download Full-text

ECG patterns related to arrhythmias and sudden death: channelopathies, early repolarization, and pre-excitation

ESC CardioMed ◽

10.1093/med/9780198784906.003.0074 ◽

2018 ◽

pp. 382-389

Author(s):

Wojciech Zareba ◽

Pyotr Platonov

Keyword(s):

Sudden Death ◽

Long Qt Syndrome ◽

Ventricular Arrhythmias ◽

Prior History ◽

Long Qt ◽

Early Repolarization ◽

Genes Encoding ◽

History Of ◽

Qt Syndrome ◽

Characteristic Features

Electrocardiogram (ECG) patterns recognized in patients with sudden death without structural abnormalities in the heart have guided cardiology over the last few decades towards a better understanding of the role of cardiac ion channels in physiology and in arrhythmogenicity in rare electrical diseases. The long QT syndrome became the paradigm for evaluating the association between specific ion channel abnormalities caused by mutations in genes encoding predominantly potassium and sodium channels and phenotypic ECG expression. Specific ECG patterns observed in long QT syndrome help in diagnosis and improve prognosis in patients affected by this disorder. Short QT syndrome also is characterized by specific patterns in repolarization morphology that relate to affected potassium current or calcium handling genes. Brugada syndrome and early repolarization syndrome are considered as J-wave syndromes, having some similarities in ECG features but with distinctive patterns associated with classical forms of these disorders. Spontaneous appearance of cove-type Brugada pattern is associated with a worse prognosis. Early repolarization patterns may also indicate prognosis in subjects with a prior history of cardiac arrest or ventricular arrhythmias or a family history of cardiac arrests. Catecholaminergic polymorphic ventricular tachycardia is another channelopathy without characteristic features in standard resting ECG but with characteristic polymorphic ventricular arrhythmias during catecholaminergic challenge (exercise test, stressing situations). Pre-excitation syndromes associated with sudden cardiac death are well recognized and current understanding of these disorders leads to a better therapy.

Download Full-text

Can Calcium, Phosphate, Calcium Phosphate Product and Intact Parathyroid Hormone Levels Be Appropriately Controlled in Dialysis Patients?

Medical Principles and Practice ◽

10.1159/000319768 ◽

2011 ◽

Vol 20 (1) ◽

pp. 85-89 ◽

Cited By ~ 2

Author(s):

S.M. Deger ◽

R. Mutluay ◽

U. Derici ◽

F. Mandiralioglu ◽

T. Arinsoy ◽

...

Keyword(s):

Parathyroid Hormone ◽

Calcium Phosphate ◽

Intact Parathyroid Hormone ◽

Dialysis Patients ◽

Hormone Levels ◽

Phosphate Product

Download Full-text

Mechanical Cardiopulmonary Resuscitation Choice of Patients on Chronic Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089001000411 ◽

1990 ◽

Vol 10 (4) ◽

pp. 299-302 ◽

Cited By ~ 2

Author(s):

Antonios H. Tzamaloukas ◽

Phillip G. Zager ◽

Barbara J. Quintana ◽

Marie Nevarez ◽

Kathleen Rogers ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Cardiopulmonary Resuscitation ◽

Sudden Death ◽

Chest Wall ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Flail Chest ◽

Chronic Peritoneal Dialysis ◽

Dialysis Patients ◽

Multiple Rib Fractures ◽

Chest Wall Trauma

Fifty-five adult patients (5 women, 50 men) on chronic peritoneal dialysis, mostly continuous ambulatory peritoneal dialysis (CAPD), for 2 to 155 mon were asked whether or not they wanted to have mechanical cardiopulmonary resuscitation (CPR) in case of sudden death. Thirty-five patients (65%) opted for CPR and 20 (36%) declined. Statistically, sex (although the number of women interviewed was too small for a valid sample) and duration of dialysis had no effect on choice of CPR, whereas older age, the presence of diabetes, advanced medical disability, and advanced socioeconomic disability were associated with a tendency to decline CPR. Among the 10 patients who had CPR, 5 developed flail chest, 4 had multiple rib fractures, and only 1 had no chest wall trauma from CPR. Two patients left the hospital alive. One third of the patients on chronic peritoneal dialysis do not want CPR. Advanced age, diabetes, and poor medical and socioeconomic states predispose peritoneal dialysis patients to decline CPR.

Download Full-text

P1194RISK FACTORS FOR CARDIOVASCULAR DEATH IN NON-DIABETIC PERITONEAL DIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1194 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Andreea Gabriella Andronesi ◽

Luminita Iliuta ◽

Cristina Cristache ◽

Bogdan Marian Sorohan ◽

Gabriela Elena Lupusoru ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Sudden Cardiac Death ◽

Calcium Phosphate ◽

Arterial Stiffness ◽

Cardiac Death ◽

Cardiovascular Death ◽

Diabetic Patients ◽

Increased Risk ◽

Phosphate Product

Abstract Background and Aims Chronic kidney disease and especially end stage renal disease are important public health issues with increasing incidence and significant economic burden. Despite advances in peritoneal dialysis (PD), mortality is still high mostly because of cardiovascular morbidity and mortality. The aim of the present study was to identify prognostic risk factors for cardiovascular death in non-diabetic PD patients. Method We performed a prospective study in which we included non-diabetic patients in stable PD programme for at least 6 months. Clinical, biological, heart and carotid ultrasound and arterial stiffness (evaluated through applanation tonometry) parameters were analysed. Independent risk factors for cardiovascular death were identified by logistic regression using IBM SPSS ver. 20.0. Results We included 246 consecutive non-diabetic patients (118F, 128M), mean age 56.3 + 15.7 years (20-85). Mean follow up was 6.5+1.1 years. 36 patients (14.6%) died because of cardiovascular reasons - sudden cardiac death 13 patients, acute coronary syndrome 8 patients, ischemic stroke 8 patients, and heart failure 7 patients. Individuals with cardiovascular death were significantly older (64.6±14.2 vs 54.7±15.5 years, p=0.01), with signs of malnutrition, inflammation and associated anemia - significantly lower total cholesterol (150.2±43.0 vs 194.3±58.2 mg/dl, p=0.002), serum albumin (2.9±0.4 vs 3.5±0.7 g/dl, p=0.002) and hemoglobin (9.7±1.1 vs 10.7±1.4 g/dl, p=0.007) and significantly higher serum fibrinogen (568.7±121.3 vs 509.8±115.0 mg/dl, p=0.04) and C-reactive protein (6.7+1.2 vs 9.5+0.9 mg/l, p=0.02). In univariate analysis risk for cardiovascular death was higher in patients with renal hypertensive disease (OR 4.0, 95%CI 1.4-11.5, p=0.01), iPTH serum level <150 pg/ml (OR 6.6, 95%CI: 2.3-18.9, p<0.001), left ventricular hypertrophy (OR 10.6, 95%CI 2.3-18.9, p=0.001) and diastolic dysfunction (OR 4.0, 95%CI 1.2-14.9, p=0.02). Compared to patients with an iPTH between 150-300 pg/ml, both patients with lower iPTH and also higher iPTH had an increased risk for cardiovascular death (OR=1.6, 95%CI: 1.2-2.0; p<0.001 for iPTH<150 pg/ml, and OR =1.2, 95%CI:1.04-1.34; p=0.01 for iPTH<300 pg/ml). Patients with cardiovascular death had signs of subclinic atherosclerosis- intima-media thickness at carotid level >0.9 mm (OR 4.3, 95%CI 1.1-16.3, p=0.02) and higher pulse wave velocity as a sign of increased arterial stiffness (11.9+2.5 vs 8.6+2.6 m/s, p=0.04). After adjusting for potential confounders, independent predictive factors for cardiovascular death were male gender, calcium-phosphate product>55 mg2/dl2, iPTH<150 pg/ml and peripheral arterial disease (Table 1). Conclusion We found an increased risk for cardiovascular death in non-diabetic PD patients, mostly because of sudden cardiac death. Malnutrition, inflammation, but especially abnormal mineral metabolism (both increased calcium-phosphate product and low bone turnover) were identified as risk factors for cardiovascular death and are potentially treatable risk factors to improve cardiovascular outcome in PD patients. A better understanding of pathogenesis and risk factors for cardiovascular death in PD may help improve patients’ management and thus their long-term survival.

Download Full-text

K/DOQI guideline requirements for calcium, phosphate, calcium phosphate product, and parathyroid hormone control in dialysis patients: can we achieve them?

International Urology and Nephrology ◽

10.1007/s11255-005-0083-x ◽

2006 ◽

Vol 38 (3-4) ◽

pp. 739-743 ◽

Cited By ~ 16

Author(s):

Mingxin Wei ◽

Hulya Taskapan ◽

Khaled Esbaei ◽

Sarbjit Vanita Jassal ◽

Joanne M. Bargman ◽

...

Keyword(s):

Parathyroid Hormone ◽

Calcium Phosphate ◽

Dialysis Patients ◽

Phosphate Product ◽

Hormone Control

Download Full-text

Which Method Should Be Used to Assess Protein Intake in Peritoneal Dialysis Patients? Assessment of Agreement Between Protein Equivalent of Total Nitrogen Appearance and 24-Hour Dietary Recall

Journal of Renal Nutrition ◽

10.1053/j.jrn.2020.08.003 ◽

2020 ◽

Author(s):

Maryanne Zilli Canedo Silva ◽

Barbara Perez Vogt ◽

Nayrana Soares Carmo Reis ◽

Rogerio Carvalho Oliveira ◽

Jacqueline Costa Teixeira Caramori

Keyword(s):

Peritoneal Dialysis ◽

Total Nitrogen ◽

Protein Intake ◽

Dialysis Patients ◽

Dietary Recall

Download Full-text

Prevalence of abnormalities in electrocardiogram conduction in dialysis patients: a comparative study

Brazilian Journal of Nephrology ◽

10.1590/10.1590/2175-8239-jbn-2020-0018 ◽

2020 ◽

Author(s):

Firas Ajam ◽

Arda Akoluk ◽

Anas Alrefaee ◽

Natasha Campbell ◽

Avais Masud ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Cardiac Conduction ◽

Future Research ◽

Dialysis Patients ◽

Bundle Branch Block ◽

Conduction Abnormality ◽

Ckd Stage ◽

Stage 1 ◽

Electrocardiogram Ecg ◽

Ecg Abnormalities

ABSTRACT Background: The electrocardiogram (ECG) can aid in identification of chronic kidney disease (CKD) patients at high risk for cardiovascular diseases. Cohort studies describe ECG abnormalities in patients on hemodialysis (HD), but we did not find data comparing ECG abnormalities among patients with normal kidney function or peritoneal dialysis (PD) to those on hemodialysis. We hypothesized that ECG conduction abnormalities would be more common, and cardiac conduction interval times longer, among patients on hemodialysis vs. those on peritoneal dialysis and CKD 1 or 2. Methods: Retrospective review of adult inpatients’ charts, comparing those with billing codes for “Hemodialysis” vs. inpatients without those charges, and an outpatient peritoneal dialysis cohort. Patients with CKD 3 or 4 were excluded. Results: One hundred and sixty-seven charts were reviewed. ECG conduction intervals were consistently and statistically longer among hemodialysis patients (n=88) vs. peritoneal dialysis (n=22) and CKD stage 1 and 2 (n=57): PR (175±35 vs 160±44 vs 157±22 msec) (p=0.009), QRS (115±32 vs. 111±31 vs 91±18 msec) (p=0.001), QT (411±71 vs. 403±46 vs 374±55 msec) (p=0.006), QTc (487±49 vs. 464±38 vs 452±52 msec) (p=0.0001). The only significantly different conduction abnormality was prevalence of left bundle branch block: 13.6% among HD patients, 5% in PD, and 2% in CKD 1 and 2 (p=0.03). Conclusion: To our knowledge, this is the first study to report that ECG conduction intervals are significantly longer as one progresses from CKD Stage 1 and 2, to PD, to HD. These and other data support the need for future research to utilize ECG conduction times to identify dialysis patients who could potentially benefit from proactive cardiac evaluations and risk reduction.

Download Full-text