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Introduction. Les atteintes du système cardiovasculaire liées à la maladie rénale chronique (MRC) peuvent avoir des répercussions sur l’activation électrique du myocarde. Notre but était de décrire les anomalies électrocardiographiques chez les patients souffrant de MRC comparativement aux patients MRC hémodialysés chroniques. Matériel et méthodes. Il s’agissait d’une étude transversale et analytique conduite à l’hôpital général de Douala de février à juin 2021. Nous avons réalisé un électrocardiogramme à 3 groupes de patients appariés selon l’âge et le sexe dont 50 sans MRC (Non MRC), 50 avec MRC non hémodialysés (MRC-ND) et 50 avec MRC hémodialysés (HD). Une valeur p < 0,05 était considérée significative. Résultats. Sur 150 patients inclus, 87 (58%) étaient de sexe masculin et l’âge moyen était similaire dans les 3 groupes (53,06 (11,64) ans chez les HD, 53,85 (11,53) ans chez les MRC ND et 53.84 (11,74) ans chez les non MRC). Les anomalies électrocardiographiques étaient significativement retrouvées chez les HD (86%) par rapport aux MRC ND (56%) et non MRC (24%) (OR=9,2 ; IC : 3,77-22,51, P < 0,0001). Ces anomalies étaient l’HVG (66%, OR = 8.84, IC : 4.06 – 19.22, p < 0,0001), l’intervalle QT allongé (28%, OR=5,16, IC :1,93 –13,84 et p = 0,001) et l’HAG (26%, OR=6.67, IC :2.27 – 20.03, p = 0,0006). Conclusion. Les anomalies ECG étaient fréquentes chez les patients HD, notamment l’HVG, l’intervalle QT allongé et l’HAG. Ces résultats incitent à améliorer les interventions spécifiques sur les causes de l’HVG chez l’hémodialysé telles l’hypertension artérielle et l’anémie.
ABSTRACT
Introduction. Chronic kidney disease (CKD)-related impairment of the cardiovascular system may affect myocardial electrical activation. The aim of this study was to describe electrocardiographic abnormalities in patients with CKD compared to stable chronic haemodialysis patients. Material and methods. This was a cross-sectional and analytical study at the Douala General Hospital from February to June 2021. We performed an electrocardiogram in 3 groups of patients matched according to age and sex, including 50 without CKD (Non-CKD), 50 with CKD but dialysis naïve (CKD-ND) and 50 with CKD on hemodialysis (HD). A p-value < 0.05 was considered significant. Result. In total, of 150 patients included, 87 (58%) were male and the mean age was similar in the 3 groups (53.06 (11.64) years in HD patients, 53.85 (11.53) years in ND CKD patients and 53.84 (11.74) years in non-CKD patients). Electrocardiographic abnormalities were significantly found (OR=9,2 ; CI : 3,77-22,51 and P < 0,0001) in HD patients (86%) than ND CKD patients (56%) and non-CKD patients (24%) . These abnormalities found in HD patients were LVH (66%, OR = 8.84, CI : 4.06 – 19.22, p < 0,0001),QT prolongation (28%, OR=5,16, CI :1,93 –13,84 and p = 0,001) and left atrial hypertrophy (LAH) (26%, OR=6.67, IC :2.27 – 20.03 and p = 0,0006). Conclusion. Electrocardiographic abnormalities are significantly more frequent in HD patients, particularly LVH, QT interval prolongation and LAH. These results suggest an improvement of specific interventions on the causes of LVH and LAH in hemodialysis patients such as arterial hypertension and anemia.
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References
- Eknoyan G, Lameire N, Eckardt K, Abboud OL, Adler S, Agarwal R et al. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney int 2013; 3: 5–14.
- Hill NR, Fatoba ST, Oke JL, Hirst JA, 0’Callaghan C, Lasserson DS et al. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One 2016; 11: e0158765.
- Ji A, Pan C, Wang H, Jin Z, Lee JH, Wu Q et al. Prevalence and Associated Risk Factors of Chronic Kidney Disease in an Elderly Population from Eastern China. IJEPH-Editorial office2019; 16: 4383.
- Peer N, George J, Lombard C, Steyn K, Levitt N, Kengne AP et al. Prevalence, concordance and associations of chronic kidney disease by five estimators in South Africa. BMC Nephrology 2020; 21: 372.
- Saran R, Robinson B, Abbott KC, Agodoa L.Y.V, Bragg-Gresham J, Balkishnan R et al. US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis 2019; 73: A7–A8.
- Shafi S, Saleem M, Anjum R, Wajid Abdullah , Tahir Shafi. ECG Abnormalities in Patients with Chronic Kidney Disease. Int.J.Environ.Res.Public Health. 2017; 29(1): 61–64.
- McManus DD, Saczynski JS, Ward JA, et al. The Relationship Between Atrial Fibrillation and Chronic Kidney Disease: Epidemiologic and Pathophysiologic Considerations for a Dual Epidemic. J Atr Fibrillation 2012; 5(1): 442.
- Babua C, Kalyesubula R, Okello E, Kakande B, Sebatta E, Mungoma M et al. Pattern and presentation of cardiac diseases among patients with chronic kidney disease attending a national referral hospital in Uganda: a cross sectional study. BMC Nephrol 2015; 16: 126.
- Sherif KA, Abo‐Salem E, Panikkath R, Nusrat E, Tuncel M. Cardiac Repolarization Abnormalities Among Patients with Various Stages of Chronic Kidney Disease. Clinical Cardiology 2014; 37(7): 417–421.
- Nies-Y, Zou J, Liang Y, Shen B, Liu Zhonghua, Cao X et al. Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis. PLOS ONE 2016; 11(5): 0155445.
- Charytan DM, Foley R, Peter A, McCullough JD, Rogers B, Zimetbaum P et al. Arrhythmia and Sudden Death in Hemodialysis Patients: Protocol and Baseline Characteristics of the Monitoring in Dialysis Study. Clin J Am Soc Nephrol. 2016; 11(4): 721–73
- Yosu Luque, Aurélien Bataille, Guillaume Taldir, Éric Rondeau, Christophe Ridel. Cardiac arrest in dialysis patients: Risk factors, preventive measures and management in 2015. Néphrologie et Thérapeutique, ElsevierMasson. 2016 ; 12 (1) : 6-17.
- Alpert MA. Sudden cardiac arrest and sudden cardiac death on dialysis: Epidemiology, evaluation, treatment, and prevention. Hemodialysis International 2011; 15(S1): S22–S29.
- Luque Y, Bataille A, Taldir G, Rondeau C, Ridel C. Arrêt cardio-respiratoire en hémodialyse chronique : facteurs de risque, prévention et conduite à tenir en 2015 Cardiac arrest in dialysis patients : risk factors, preventive measures and management in 2015 ; 12(1) :6-17
- Kyelem CG, Sempore YW, Yameogo AA, Drissa S, Semde H, Ilboudo A al. Diagnostic et prise en charge de la maladie rénale chronique dans un contexte de ressources limitées: spécificités et difficultés d’un service de Médecine interne. Rev.Afr. Med Interne 2020; 7: 11–19.
- Halle MP, Ashuntantang G, Kaze FF, Takongue C, Kengne AP. Fatal outcomes among patients on maintenance haemodialysis in sub-Saharan Africa: a 10-year audit from the Douala General Hospital in Cameroon. BMC Nephrol 2016; 17(1): 165.
- Aseneh JB, Kemah B-LA, Mabouna S, Njang E, Ekane DS, Agbor. Chronic Kidney Disease in Cameroon: A scoping review.
- Chijioke A, Makusidi AM, Kolo PM. Electrocardiographic abnormalities among dialysis naïve chronic kidney disease patients in Ilorin Nigeria. Annals of African Medicine2012; 11(1): 21-26.
- Kaze FF, Kengne A-P, Djalloh AMA, Ashuntantang G, Halle MP, Menanga AP et al. Pattern and correlates of cardiac lesions in a group of sub-Saharan African patients on maintenance hemodialysis. Pan African Medical Journal; 17(1)
- Hamadou B, Halle M, Kamdem F, Mbia M, Amougou S, Boombhi J et al. Cardiac arrhythmia during chronic hemodialysis: A cross sectional Holter ECG study in patients from North Cameroon. Health Sciences and Diseases.2017;
- Halle MP, Djamtip H, Kaze FF, Teuwafeu D, Fouda Hermine, Ashuntantang G. Intradialytic hypotension and associated factors among patients on maintenance hemodialysis: A single-center study in cameroon. Saudi J Kidney Dis Transpl 2020 ; 31 : 215–223
- Izeidi PPM, Nlandu YM, Lepira FB, Makulo JRR, Engole YM, Mokoli VM et al. Cost estimate of chronic hemodialysis in Kinshasa, the Democratic Republic of the Congo: A prospective study in two centers. Hemodialysis International 2020; 24(1): 121–128.
- Sohal PM, Goel A, Gupta D, Aslam N, Sandhu J, Sandhu JS et al. Effect of Hemodialysis on Corrected QT Interval and QTc Dispersion. Indian J Nephrol 2018; 28 (5): 335–338
- Vareesangthip K, Yincharoen P, Winijkul A, Chanchairujira T. Cardiac Arrhythmia During Early-Week and Mid-Week Dialysis in Hemodialysis Patients. Therapeutic Apheresis and Dialysis 2021; 16(1): 211-216.
- Mhammedi SA, Hamdi F, Benabdelhak M, Bentata Y, Haddiya I. [Therapeutic compliance: another challenge for patients on chronic haemodialysis]. Pan Afr Med J 2019; 33(2): 28.
- Tsai W-C, Wu H-Y, Peng Y-S, Ko M-Y, Wu K-D, Chu T-S et al. Risk Factors for Development and Progression of Chronic Kidney Disease: A Systematic Review and Exploratory Meta-Analysis. Medicine 2016 ; 95 (11) : e3013.
- Serge Muleka Ngoie, Philippe Mulenga, Olivier Mukuku, Christian Ngama Kakisingi, Cédrick Milindi Sangwa, Pascal Tshimwang Nawej, Claude Mulumba Mwamba, Dophra Nkulu Ngoy, Faustin Wa Pa Manda Muteta. Maladie rénale chronique : facteurs associés, étiologies, caractéristiques clinique et biologique à Lubumbashi en République Démocratique du Congo. Pan African Medical Journal. 2017 ;28 :41.
- Fouda H, Ashuntantang G, Kaze F, Halle MP. La survie en hémodialyse chronique au Cameroun. Pan Afr Med J 2017; 26(1):97
- McCullough PA, Chan CT, Weinhandl ED, Burkart JM, Bakris GL. Intensive Hemodialysis, Left Ventricular Hypertrophy, and cardiovascular disease. American Journal of Kidney Diseases 2016; 68(5): S5–S14.
- Burdette S, Roppolo LP, Green W, Shinthia N, Ye P, Hynan LS. The Effect of Antiemetics and Antihistamines on the QTc Interval in Emergent Dialysis Patients with Baseline QTc Prolongation. The Journal of Emergency Medicine 2016; 51(1): 99–105.
- Liu P, Han D, Sun X, et al. Prevalence and risk factors of acquired long QT syndrome in hospitalized patients with chronic kidney disease. Journal of Investigative Medicine 2019; 67: 289–294.
- Matsumoto Y, Mori Y, Kageyama S, Arihara K, Sato H, Nagata K et al. Changes in QTc interval in long-term hemodialysis patients. PLoS One 2019; 14(1): e0209297.
- Ajam F, Akoluk A, Alrefaee A, Campbell N, Masud A, Mehandu S et al. Prevalence of abnormalities in electrocardiogram conduction in dialysis patients: a comparative study. J Bras Nefrol 2020; 42(4): 448–453.
References
Eknoyan G, Lameire N, Eckardt K, Abboud OL, Adler S, Agarwal R et al. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney int 2013; 3: 5–14.
Hill NR, Fatoba ST, Oke JL, Hirst JA, 0’Callaghan C, Lasserson DS et al. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One 2016; 11: e0158765.
Ji A, Pan C, Wang H, Jin Z, Lee JH, Wu Q et al. Prevalence and Associated Risk Factors of Chronic Kidney Disease in an Elderly Population from Eastern China. IJEPH-Editorial office2019; 16: 4383.
Peer N, George J, Lombard C, Steyn K, Levitt N, Kengne AP et al. Prevalence, concordance and associations of chronic kidney disease by five estimators in South Africa. BMC Nephrology 2020; 21: 372.
Saran R, Robinson B, Abbott KC, Agodoa L.Y.V, Bragg-Gresham J, Balkishnan R et al. US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis 2019; 73: A7–A8.
Shafi S, Saleem M, Anjum R, Wajid Abdullah , Tahir Shafi. ECG Abnormalities in Patients with Chronic Kidney Disease. Int.J.Environ.Res.Public Health. 2017; 29(1): 61–64.
McManus DD, Saczynski JS, Ward JA, et al. The Relationship Between Atrial Fibrillation and Chronic Kidney Disease: Epidemiologic and Pathophysiologic Considerations for a Dual Epidemic. J Atr Fibrillation 2012; 5(1): 442.
Babua C, Kalyesubula R, Okello E, Kakande B, Sebatta E, Mungoma M et al. Pattern and presentation of cardiac diseases among patients with chronic kidney disease attending a national referral hospital in Uganda: a cross sectional study. BMC Nephrol 2015; 16: 126.
Sherif KA, Abo‐Salem E, Panikkath R, Nusrat E, Tuncel M. Cardiac Repolarization Abnormalities Among Patients with Various Stages of Chronic Kidney Disease. Clinical Cardiology 2014; 37(7): 417–421.
Nies-Y, Zou J, Liang Y, Shen B, Liu Zhonghua, Cao X et al. Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis. PLOS ONE 2016; 11(5): 0155445.
Charytan DM, Foley R, Peter A, McCullough JD, Rogers B, Zimetbaum P et al. Arrhythmia and Sudden Death in Hemodialysis Patients: Protocol and Baseline Characteristics of the Monitoring in Dialysis Study. Clin J Am Soc Nephrol. 2016; 11(4): 721–73
Yosu Luque, Aurélien Bataille, Guillaume Taldir, Éric Rondeau, Christophe Ridel. Cardiac arrest in dialysis patients: Risk factors, preventive measures and management in 2015. Néphrologie et Thérapeutique, ElsevierMasson. 2016 ; 12 (1) : 6-17.
Alpert MA. Sudden cardiac arrest and sudden cardiac death on dialysis: Epidemiology, evaluation, treatment, and prevention. Hemodialysis International 2011; 15(S1): S22–S29.
Luque Y, Bataille A, Taldir G, Rondeau C, Ridel C. Arrêt cardio-respiratoire en hémodialyse chronique : facteurs de risque, prévention et conduite à tenir en 2015 Cardiac arrest in dialysis patients : risk factors, preventive measures and management in 2015 ; 12(1) :6-17
Kyelem CG, Sempore YW, Yameogo AA, Drissa S, Semde H, Ilboudo A al. Diagnostic et prise en charge de la maladie rénale chronique dans un contexte de ressources limitées: spécificités et difficultés d’un service de Médecine interne. Rev.Afr. Med Interne 2020; 7: 11–19.
Halle MP, Ashuntantang G, Kaze FF, Takongue C, Kengne AP. Fatal outcomes among patients on maintenance haemodialysis in sub-Saharan Africa: a 10-year audit from the Douala General Hospital in Cameroon. BMC Nephrol 2016; 17(1): 165.
Aseneh JB, Kemah B-LA, Mabouna S, Njang E, Ekane DS, Agbor. Chronic Kidney Disease in Cameroon: A scoping review.
Chijioke A, Makusidi AM, Kolo PM. Electrocardiographic abnormalities among dialysis naïve chronic kidney disease patients in Ilorin Nigeria. Annals of African Medicine2012; 11(1): 21-26.
Kaze FF, Kengne A-P, Djalloh AMA, Ashuntantang G, Halle MP, Menanga AP et al. Pattern and correlates of cardiac lesions in a group of sub-Saharan African patients on maintenance hemodialysis. Pan African Medical Journal; 17(1)
Hamadou B, Halle M, Kamdem F, Mbia M, Amougou S, Boombhi J et al. Cardiac arrhythmia during chronic hemodialysis: A cross sectional Holter ECG study in patients from North Cameroon. Health Sciences and Diseases.2017;
Halle MP, Djamtip H, Kaze FF, Teuwafeu D, Fouda Hermine, Ashuntantang G. Intradialytic hypotension and associated factors among patients on maintenance hemodialysis: A single-center study in cameroon. Saudi J Kidney Dis Transpl 2020 ; 31 : 215–223
Izeidi PPM, Nlandu YM, Lepira FB, Makulo JRR, Engole YM, Mokoli VM et al. Cost estimate of chronic hemodialysis in Kinshasa, the Democratic Republic of the Congo: A prospective study in two centers. Hemodialysis International 2020; 24(1): 121–128.
Sohal PM, Goel A, Gupta D, Aslam N, Sandhu J, Sandhu JS et al. Effect of Hemodialysis on Corrected QT Interval and QTc Dispersion. Indian J Nephrol 2018; 28 (5): 335–338
Vareesangthip K, Yincharoen P, Winijkul A, Chanchairujira T. Cardiac Arrhythmia During Early-Week and Mid-Week Dialysis in Hemodialysis Patients. Therapeutic Apheresis and Dialysis 2021; 16(1): 211-216.
Mhammedi SA, Hamdi F, Benabdelhak M, Bentata Y, Haddiya I. [Therapeutic compliance: another challenge for patients on chronic haemodialysis]. Pan Afr Med J 2019; 33(2): 28.
Tsai W-C, Wu H-Y, Peng Y-S, Ko M-Y, Wu K-D, Chu T-S et al. Risk Factors for Development and Progression of Chronic Kidney Disease: A Systematic Review and Exploratory Meta-Analysis. Medicine 2016 ; 95 (11) : e3013.
Serge Muleka Ngoie, Philippe Mulenga, Olivier Mukuku, Christian Ngama Kakisingi, Cédrick Milindi Sangwa, Pascal Tshimwang Nawej, Claude Mulumba Mwamba, Dophra Nkulu Ngoy, Faustin Wa Pa Manda Muteta. Maladie rénale chronique : facteurs associés, étiologies, caractéristiques clinique et biologique à Lubumbashi en République Démocratique du Congo. Pan African Medical Journal. 2017 ;28 :41.
Fouda H, Ashuntantang G, Kaze F, Halle MP. La survie en hémodialyse chronique au Cameroun. Pan Afr Med J 2017; 26(1):97
McCullough PA, Chan CT, Weinhandl ED, Burkart JM, Bakris GL. Intensive Hemodialysis, Left Ventricular Hypertrophy, and cardiovascular disease. American Journal of Kidney Diseases 2016; 68(5): S5–S14.
Burdette S, Roppolo LP, Green W, Shinthia N, Ye P, Hynan LS. The Effect of Antiemetics and Antihistamines on the QTc Interval in Emergent Dialysis Patients with Baseline QTc Prolongation. The Journal of Emergency Medicine 2016; 51(1): 99–105.
Liu P, Han D, Sun X, et al. Prevalence and risk factors of acquired long QT syndrome in hospitalized patients with chronic kidney disease. Journal of Investigative Medicine 2019; 67: 289–294.
Matsumoto Y, Mori Y, Kageyama S, Arihara K, Sato H, Nagata K et al. Changes in QTc interval in long-term hemodialysis patients. PLoS One 2019; 14(1): e0209297.
Ajam F, Akoluk A, Alrefaee A, Campbell N, Masud A, Mehandu S et al. Prevalence of abnormalities in electrocardiogram conduction in dialysis patients: a comparative study. J Bras Nefrol 2020; 42(4): 448–453.