Sudden death and interval QTc in hemodialysis patients

The aim: to evaluate the percentage of sudden cardiac death (SCD) in dialysis population and its relation to the QTc duration as a fatal arrhythmia factor and the predictors for its duration at baseline, during dialysis session and during follow-up. Patients and method: SCD percentage was evaluated in 1229 cases of death. In prospective follow-up research, 159 patients in one dialysis center, the QTc duration was measured three times with 5 months interval. Results: in 45% cases of sudden death occurred in average after 31 (10÷65) months of dialysis compared with 36 (21÷68) months in non-SCD cases and 41 (13÷76) months among alive patients. The cases of SCD have uniform distribution during the week while non-SCD cases were shifted towards long interdialytic interval (p=0.044). QTc was prolonged in 17% of patients and was longer in hyperphosphatemia (p=0.04) and at higher comorbidity; the higher LVMI (by 10 g/m2) was linked with longer QTc (by 6-7 msec); QTc correlated with end-diastolic volume (r=+0.264; p=0.002), with end-systolic volume (r=+0.372; p<0.001), with left atrium diameter (r=+0.172; p=0.05). A prolongation of QTc during the dialysis session (+6±35 msec; p=0.059) was associated with ultrafiltration (r=0.23; p=0.01) and potassium level higher than its median level of 5.13 mM (+8±26; p<0.05). In follow-up period, the stable QTc duration correlated with higher calcemia and phosphatemia (p<0.05). Conclusion: SCD is frequent in dialysis patients; QTc measurement enables one to assess the risk of fatal arrhythmia. The duration length and the prolongation of QTc in dialysis session and during follow-up are associated with preventable and modifiable factors (cardiac remodeling, fluid and ionic balance, mineral and bone disorders parameters).

гемодиализ, скорректированный интервал QT, гипергидратация, гиперфосфатемия, гиперкальциемия, гипертрофия левого желудочка, hemodialysis, corrected QT interval, volume overload, hyperphosphatemia, hypercalcemia, cardiac remodeling, left ventricular hypertrophy

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