Berta E, Erdei A, Cseke B, Gazdag A, Paragh G, Balla J, Polgar P, Nagy E V, Bodor M
Division of Endocrinology, Department of Medicine, University of Debrecen Medical and Health Science Center, Debrecen, Hungary.
Pharmazie. 2012 May;67(5):380-3.
Cardiovascular diseases are frequent complications of end-stage kidney disease. The aim of the present study was to prove the arrhythmogenic effect of dialysis using signal averaged ECG. The ECG changes and laboratory parameters (sodium, potassium, urea and creatinine levels) were detected during hemodialysis treatment in 26 patients suffering from end-stage kidney disease. The tests and the ECG were performed four times, before (0. minute), during (at 15 and 90 min), and eventually after dialysis (at 240 min). The duration of the QRS complex, high-frequency low-amplitude signals (HFLA), and root-mean-square voltage of the terminal 40 ms of the filtered QRS (RMS) were determined. We considered test results to be positive when two of the three tested parameters were outside the normal range: QRS > 120 ms, RMS < 20 uV, HFLA > 39 ms. Signal averaged ECG was positive in two cases (8%) before and after the dialysis. The duration of the QRS-complex increased significantly during the dialysis (predialysis: 109 +/- 7.6 ms, postdialysis: 116 +/- 8.0 ms, p < 0.0001). Serum urea nitrogen (predialysis: 26.2 +/- 5.4, postdialysis: 11.4 +/- 3.3 mmol/l, p <0.0001) and serum creatinine levels (predialysis: 931 +/- 212, postdialysis: 434 +/- 120 micromol/I, p < 0.0001) decreased significantly during the treatment. Significant and continuous decrease in the potassium levels were detected (predialysis: 5.30 +/- 0.72, postdialysis: 3.91 +/- 0.42 mmol/I, p < 0.0001) during the dialysis. Serum sodium levels (predialysis: 139 +/- 2.7, postdialysis: 141.4 +/- 2.2 mmol/I) had not changed during the dialysis. A significant negative correlation was found between decreasing potassium levels and increasing QRS duration (r = - 0.48, p = 0.01). Our results support our primer assumption that the metabolic changes during dialysis treatment can lead to considerable risk of cardiac arrhythmias.
心血管疾病是终末期肾病常见的并发症。本研究的目的是通过信号平均心电图来证实透析的致心律失常作用。对26例终末期肾病患者进行血液透析治疗期间，检测其心电图变化及实验室参数（钠、钾、尿素和肌酐水平）。检测和心电图检查进行了4次，分别在透析前（0分钟）、透析中（15分钟和90分钟）以及透析后（240分钟）。测定QRS波群时限、高频低幅信号（HFLA）以及滤波后QRS波群终末40毫秒的均方根电压（RMS）。当三个检测参数中的两个超出正常范围时，我们认为检测结果为阳性：QRS＞120毫秒、RMS＜20微伏、HFLA＞39毫秒。透析前后各有两例（8%）信号平均心电图结果为阳性。透析期间QRS波群时限显著增加（透析前：109±7.6毫秒，透析后：116±8.0毫秒，p＜0.0001）。血清尿素氮（透析前：26.2±5.4，透析后：11.4±3.3毫摩尔/升，p＜0.0001）和血清肌酐水平（透析前：931±212，透析后：434±120微摩尔/升，p＜0.0001）在治疗期间显著下降。透析期间检测到血钾水平显著持续下降（透析前：5.30±0.72，透析后：3.91±0.42毫摩尔/升，p＜0.0001）。血清钠水平（透析前：139±2.7，透析后：141.4±2.2毫摩尔/升）在透析期间未发生变化。血钾水平下降与QRS时限增加之间存在显著负相关（r = - 0.48，p = 0.01）。我们的结果支持我们最初的假设，即透析治疗期间的代谢变化可导致相当大的心律失常风险。
