Associations of serum and dialysate electrolytes with QT interval and prolongation in incident hemodialysis: The Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study

Esther D. Kim, Jacqueline Watt, Larisa Tereshchenko, Bernard G. Jaar, Stephen M. Sozio, W. H.Linda Kao, Michelle M. Estrella, Rulan S. Parekh

    Research output: Contribution to journalArticle

    Abstract

    Background: Prolonged QT interval in hemodialysis patients may be associated with sudden cardiac death, however, few studies examined the longitudinal associations of modifiable factors such as serum and dialysate concentrations of calcium, potassium, and magnesium with corrected QT (QTc) prolongation in incident hemodialysis patients. Methods: In 330 in-center hemodialysis participants from the PACE study who were followed up for one year, we examined the associations of predialysis serum electrolytes (total calcium [Ca], corrected Ca [cCa], ionized Ca [iCa], potassium [K], magnesium [Mg]), dialysate (dCa and dK), and serum-to-dialysate gradient measures with QTc interval and prolongation (≥460 ms in women and ≥ 450 ms in men). Results: At the first study visit, 47% had QTc prolongation. Lower iCa and K were associated with longer QTc interval independent of potential confounders (QTc difference = 8.55[95% CI: 2.13, 14.97] ms for iCa; QTc difference = 9.89[1.58, 18.20] ms for K). Lower iCa was also associated with a higher risk of QTc prolongation. At 1 year of follow-up, 31% had persistent QTc prolongation. In longitudinal analyses, the associations of iCa and K with QTc interval remained significant, and lower K was associated with a higher risk of QTc prolongation while the association of iCa with QTc prolongation was borderline statistically significant. Serum Mg, dCa or dK, and respective gradients were not associated with QTc interval or prolongation. Conclusion: Prolonged QTc is very common in incident hemodialysis participants and persists over follow-up. Ionized Ca and K are consistently inversely associated with QTc prolongation, which suggests closer monitoring for a low calcium or potassium level to mitigate risk.

    Original languageEnglish (US)
    Article number133
    JournalBMC Nephrology
    Volume20
    Issue number1
    DOIs
    StatePublished - Apr 18 2019

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    Dialysis Solutions
    Electrolytes
    Chronic Kidney Failure
    Renal Dialysis
    Calcium
    Magnesium
    Serum
    Potassium
    Sudden Cardiac Death
    Longitudinal Studies

    Keywords

    • Arrhythmia
    • Electrolytes
    • Hemodialysis
    • QT interval
    • QT prolongation

    ASJC Scopus subject areas

    • Nephrology

    Cite this

    Associations of serum and dialysate electrolytes with QT interval and prolongation in incident hemodialysis : The Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study. / Kim, Esther D.; Watt, Jacqueline; Tereshchenko, Larisa; Jaar, Bernard G.; Sozio, Stephen M.; Kao, W. H.Linda; Estrella, Michelle M.; Parekh, Rulan S.

    In: BMC Nephrology, Vol. 20, No. 1, 133, 18.04.2019.

    Research output: Contribution to journalArticle

    Kim, Esther D. ; Watt, Jacqueline ; Tereshchenko, Larisa ; Jaar, Bernard G. ; Sozio, Stephen M. ; Kao, W. H.Linda ; Estrella, Michelle M. ; Parekh, Rulan S. / Associations of serum and dialysate electrolytes with QT interval and prolongation in incident hemodialysis : The Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study. In: BMC Nephrology. 2019 ; Vol. 20, No. 1.
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    abstract = "Background: Prolonged QT interval in hemodialysis patients may be associated with sudden cardiac death, however, few studies examined the longitudinal associations of modifiable factors such as serum and dialysate concentrations of calcium, potassium, and magnesium with corrected QT (QTc) prolongation in incident hemodialysis patients. Methods: In 330 in-center hemodialysis participants from the PACE study who were followed up for one year, we examined the associations of predialysis serum electrolytes (total calcium [Ca], corrected Ca [cCa], ionized Ca [iCa], potassium [K], magnesium [Mg]), dialysate (dCa and dK), and serum-to-dialysate gradient measures with QTc interval and prolongation (≥460 ms in women and ≥ 450 ms in men). Results: At the first study visit, 47{\%} had QTc prolongation. Lower iCa and K were associated with longer QTc interval independent of potential confounders (QTc difference = 8.55[95{\%} CI: 2.13, 14.97] ms for iCa; QTc difference = 9.89[1.58, 18.20] ms for K). Lower iCa was also associated with a higher risk of QTc prolongation. At 1 year of follow-up, 31{\%} had persistent QTc prolongation. In longitudinal analyses, the associations of iCa and K with QTc interval remained significant, and lower K was associated with a higher risk of QTc prolongation while the association of iCa with QTc prolongation was borderline statistically significant. Serum Mg, dCa or dK, and respective gradients were not associated with QTc interval or prolongation. Conclusion: Prolonged QTc is very common in incident hemodialysis participants and persists over follow-up. Ionized Ca and K are consistently inversely associated with QTc prolongation, which suggests closer monitoring for a low calcium or potassium level to mitigate risk.",
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    T1 - Associations of serum and dialysate electrolytes with QT interval and prolongation in incident hemodialysis

    T2 - The Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study

    AU - Kim, Esther D.

    AU - Watt, Jacqueline

    AU - Tereshchenko, Larisa

    AU - Jaar, Bernard G.

    AU - Sozio, Stephen M.

    AU - Kao, W. H.Linda

    AU - Estrella, Michelle M.

    AU - Parekh, Rulan S.

    PY - 2019/4/18

    Y1 - 2019/4/18

    N2 - Background: Prolonged QT interval in hemodialysis patients may be associated with sudden cardiac death, however, few studies examined the longitudinal associations of modifiable factors such as serum and dialysate concentrations of calcium, potassium, and magnesium with corrected QT (QTc) prolongation in incident hemodialysis patients. Methods: In 330 in-center hemodialysis participants from the PACE study who were followed up for one year, we examined the associations of predialysis serum electrolytes (total calcium [Ca], corrected Ca [cCa], ionized Ca [iCa], potassium [K], magnesium [Mg]), dialysate (dCa and dK), and serum-to-dialysate gradient measures with QTc interval and prolongation (≥460 ms in women and ≥ 450 ms in men). Results: At the first study visit, 47% had QTc prolongation. Lower iCa and K were associated with longer QTc interval independent of potential confounders (QTc difference = 8.55[95% CI: 2.13, 14.97] ms for iCa; QTc difference = 9.89[1.58, 18.20] ms for K). Lower iCa was also associated with a higher risk of QTc prolongation. At 1 year of follow-up, 31% had persistent QTc prolongation. In longitudinal analyses, the associations of iCa and K with QTc interval remained significant, and lower K was associated with a higher risk of QTc prolongation while the association of iCa with QTc prolongation was borderline statistically significant. Serum Mg, dCa or dK, and respective gradients were not associated with QTc interval or prolongation. Conclusion: Prolonged QTc is very common in incident hemodialysis participants and persists over follow-up. Ionized Ca and K are consistently inversely associated with QTc prolongation, which suggests closer monitoring for a low calcium or potassium level to mitigate risk.

    AB - Background: Prolonged QT interval in hemodialysis patients may be associated with sudden cardiac death, however, few studies examined the longitudinal associations of modifiable factors such as serum and dialysate concentrations of calcium, potassium, and magnesium with corrected QT (QTc) prolongation in incident hemodialysis patients. Methods: In 330 in-center hemodialysis participants from the PACE study who were followed up for one year, we examined the associations of predialysis serum electrolytes (total calcium [Ca], corrected Ca [cCa], ionized Ca [iCa], potassium [K], magnesium [Mg]), dialysate (dCa and dK), and serum-to-dialysate gradient measures with QTc interval and prolongation (≥460 ms in women and ≥ 450 ms in men). Results: At the first study visit, 47% had QTc prolongation. Lower iCa and K were associated with longer QTc interval independent of potential confounders (QTc difference = 8.55[95% CI: 2.13, 14.97] ms for iCa; QTc difference = 9.89[1.58, 18.20] ms for K). Lower iCa was also associated with a higher risk of QTc prolongation. At 1 year of follow-up, 31% had persistent QTc prolongation. In longitudinal analyses, the associations of iCa and K with QTc interval remained significant, and lower K was associated with a higher risk of QTc prolongation while the association of iCa with QTc prolongation was borderline statistically significant. Serum Mg, dCa or dK, and respective gradients were not associated with QTc interval or prolongation. Conclusion: Prolonged QTc is very common in incident hemodialysis participants and persists over follow-up. Ionized Ca and K are consistently inversely associated with QTc prolongation, which suggests closer monitoring for a low calcium or potassium level to mitigate risk.

    KW - Arrhythmia

    KW - Electrolytes

    KW - Hemodialysis

    KW - QT interval

    KW - QT prolongation

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