Nephrology-Dialysis Department, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam.
Department of Nephrology-Urology-Transplantation, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
Blood Purif. 2023;52(5):493-502. doi: 10.1159/000529664. Epub 2023 Mar 30.
This study aimed to evaluate the effects of dialysis on change of QT interval in pre-dialysis, 1 h after dialysis initiation, and post-dialysis period in patients on maintenance dialysis (MHD).
An observational prospective study was conducted, including 61 patients, on thrice-weekly MHD ≥3 months, and without acute diseases, at the Nephrology-Dialysis Department of a tertiary hospital in Vietnam. The exclusive criteria were atrial fibrillation, atrial flutter, branch block, prolonged QT recorded in medical history, and taking antiarrhythmic drugs lengthening QT interval before entering the study. Twelve-lead electrocardiographs and blood chemistries were done simultaneously before, 1 h after initiation, and after the dialysis session.
The proportion of patients with prolonged QT interval increased significantly from 44.3% in pre-dialysis to 77% 1 h after dialysis initiation and 86.9% in post-dialysis session. Immediately after dialysis, the QT and QTc intervals on all 12 leads were significantly longer. Post-dialysis levels of potassium, chloride, magnesium, and urea decreased significantly from 3.97 (0.7), 98.6 (4.7), 1.04 (0.2), and 21.4 (6.1) to 2.78 (0.4), 96.6 (2.5), 0.87 (0.2), and 6.33 (2.8) mmol/L, respectively, whereas the calcium increased significantly from 2.19 (0.2) to 2.57 (0.2) mmol/L. There were significant differences in the potassium level at the dialysis initiation and its speed of reduction between the group without and with prolonged QT interval.
There was an increased risk of prolonged QT interval in MHD patients regardless of the absence of the previous abnormal QT interval. Notably, this risk increased rapidly 1 h after the initiation of dialysis.
本研究旨在评估透析对维持性血液透析（MHD）患者透析前、透析开始后 1 小时和透析后期间 QT 间期变化的影响。
在越南一家三级医院的肾脏病透析科进行了一项观察性前瞻性研究，纳入了 61 名至少接受了 3 个月每周 3 次 MHD 且无急性疾病的患者。排除标准为心房颤动、心房扑动、分支阻滞、既往病史中记录有 QT 延长以及在入组前使用抗心律失常药物延长 QT 间期。在透析前、透析开始后 1 小时和透析后同时进行 12 导联心电图和血液化学检查。
透析前有延长 QT 间期的患者比例从 44.3%显著增加至透析开始后 1 小时的 77%和透析后 86.9%。透析后即刻，所有 12 个导联的 QT 和 QTc 间期显著延长。透析后血清钾、氯、镁和尿素水平分别从 3.97（0.7）、98.6（4.7）、1.04（0.2）和 21.4（6.1）mmol/L 显著降低至 2.78（0.4）、96.6（2.5）、0.87（0.2）和 6.33（2.8）mmol/L，而钙水平从 2.19（0.2）mmol/L 显著升高至 2.57（0.2）mmol/L。在无延长 QT 间期和有延长 QT 间期的患者中，透析开始时的钾水平及其降低速度存在显著差异。
MHD 患者即使没有既往异常 QT 间期，也存在延长 QT 间期的风险。值得注意的是，这种风险在透析开始后 1 小时内迅速增加。
