Zhang Wenjing, Liang Yu, Lv Jia, Li Yan, Sun Jiping
Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shannxi, China.
BMC Nephrol. 2022 Feb 18;23(1):69. doi: 10.1186/s12882-022-02685-y.
Patients with chronic kidney disease (CKD) are at a high risk of fatal arrhythmias. The extended corrected QT (QTc) interval is a hallmark of ventricular arrhythmias and sudden cardiac death. Previous studies have shown that QT interval and QTc are prolonged with the decline in renal function. However, there were no available results for patients with peritoneal dialysis (PD). In this study, we examined changes in QT interval and QTc in patients with end-stage renal disease (ESRD) who underwent peritoneal dialysis.
A total of 66 ESRD patients who received PD, including 50 males and 16 females, with an average age of 43.56 ± 15.15 years, were enrolled. The follow-up lasted 1 year. The demographics and the etiology of patients were recorded. QTc and clinical/biochemical indexes before dialysis and at 6 and 12 months were determined and analyzed. Dialysis adequacy and peritoneal transport function were assessed in each patient. Analysis of variance (ANOVA), least significant difference (LSD) or Tamhane's T2, Paired T-test, Chi-square test, multiple linear regression analysis, and Pearson correlation coefficient were used to analyze the data. P < 0.05 was considered as statistically significant.
With reference to etiology, 37 patients (56.06%) had chronic nephritis, and 11 (16.67%) had diabetic nephropathy. Most of the peritoneal transport functions were low average transport (25, 37.88%), while the least were high transport (2, 3.03%).During the follow-up period, all patients had adequate peritoneal dialysis. Compared with a baseline before dialysis, anemia, low albumin, blood pressure, blood urea nitrogen, creatinine, uric acid, potassium, calcium, phosphorus, and parathyroid hormone improved after 6 and 12 months, while the residual renal function gradually decreased during the follow-up. The mean QTc of all patients was stable during the follow-up period. According to gender, the QTc in males and female patients were similar. Before PD, diastolic blood pressure, calcium concentration, and hemoglobin level were negatively correlated with QTc in end-stage renal disease patients; After PD, the observed clinical indexes were no longer relevant to QTc.
Unlike hemodialysis-induced QTc prolongation, PD did not increase the patient's QT interval and QTc interval, which suggested that myocardial electrical activity might be more stable in patients with adequate peritoneal dialysis.
慢性肾脏病（CKD）患者发生致命性心律失常的风险很高。校正QT间期延长是室性心律失常和心源性猝死的一个标志。既往研究表明，QT间期和校正QT间期会随着肾功能下降而延长。然而，腹膜透析（PD）患者尚无相关研究结果。在本研究中，我们检测了接受腹膜透析的终末期肾病（ESRD）患者的QT间期和校正QT间期变化。
共纳入66例接受腹膜透析的ESRD患者，其中男性50例，女性16例，平均年龄43.56±15.15岁。随访持续1年。记录患者的人口统计学资料和病因。测定并分析透析前、透析6个月和12个月时的校正QT间期及临床/生化指标。评估每位患者的透析充分性和腹膜转运功能。采用方差分析（ANOVA）、最小显著差异法（LSD）或Tamhanes T2检验、配对t检验、卡方检验、多元线性回归分析和Pearson相关系数分析数据。P<0.05被认为具有统计学意义。
就病因而言，37例患者（56.06%）患有慢性肾炎，11例（16.67%）患有糖尿病肾病。大多数患者的腹膜转运功能为低平均转运（25例，37.88%），而高转运患者最少（2例，3.03%）。在随访期间，所有患者的腹膜透析均充分。与透析前基线相比，6个月和12个月后贫血、低白蛋白、血压、血尿素氮、肌酐、尿酸、钾、钙、磷和甲状旁腺激素均有所改善，而随访期间残余肾功能逐渐下降。所有患者的平均校正QT间期在随访期间保持稳定。按性别分组，男性和女性患者的校正QT间期相似。在腹膜透析前，舒张血压、钙浓度和血红蛋白水平与终末期肾病患者的校正QT间期呈负相关；腹膜透析后，观察到的临床指标与校正QT间期不再相关。
与血液透析导致校正QT间期延长不同，腹膜透析并未增加患者的QT间期和校正QT间期，这表明腹膜透析充分的患者心肌电活动可能更稳定。
