Electrocardiographic abnormalities during the inaugural session of haemodialysis in incidents patients with End Stage Renal Disease

Dorothée Emmanuelle SOH MANKONG
Département de médecine interne et spécialités, FMSB, Université de Yaoundé I
July, 2015
 

Abstract

Context
Haemodialysis (HD) is the most prevalent method of renal replacement in end stage renal disease (ESRD). Despite the increase in patient survival, morbidity and mortality remain high in ESRD patients treated with haemodialysis. The mortality rate on HD estimated has at 40-55%, in cardiovascular disorders especially sudden deaths and heart failure account for the major part of this mortality. Electrophysiological changes of the heart resulting from the hemodynamic changes and electrolyte movements during the process of HD may account for sudden deaths. The incidence of
electrocardiographic abnormalities in prevalent patients during HD varies from 17-70% in USA. Considering the growing HD population in Cameroon and the high early mortality observed in this population, it is important to explore preventable contributors to this high mortality.
Objectives
We therefore aimed to evaluate the incidence and types of electrocardiographic abnormalities during the inaugural sessions of HD among patients with ESRD. We also determined factors associated with these abnormalities.
Materials and methods:
This was a cross-sectional analytical study carried out from January 2015 to May 2015 at the haemodialysis unit of the Yaounde General Hospital. All consenting incident patients with ESRD were eligible. Patients with a history of cardiac rhythm or conduction disorders were excluded. Relevant clinical data were noted. Serum calcium, bicarbonate, magnesium, potassium, sodium and creatinine were measured before and after the dialysis session
using AUDICOM ionometer .Haemodialysis data including ultrafiltration rate, dialysate composition, vascular access type, duration of session and incidents during the session were noted. Continuous ECG was done over a 5
hour period using a HOLTER CONTEC TLC 5000. The recording begun one hour before the dialysis session and continued till 2 hours post dialysis; After validation of the recordings analysis, the electrocardiographic recording
was analysed using a software 12 channels ECG Holter System _TF.Data was analyzed with the aid of the CSPro version5.0. and SPSS version 18.0. Kolmogorov test and Mann-Whitney-Wilcoxon test were used to compare means and medians as necessary. Association between the variables was evaluated by
the univarious analysis. The level of statistical significance was set at a valeur p<0, 05.
Results
A total 24 participants met the inclusion criteria, 2 were excluded. Their mean age was 49±10.32 years. Males accounted for 77%. Hypertension (n=19; 86.4%) and diabetes (n=6; 27.3%) were the main comorbidities noted. 87% of the participants rejoined emergency dialysis. Mean predialysis haemoglobin=7.8g/dl ±1.55. Serum potassium (4.57±0.69Vs3.30±0.58; p=0.000), magnesium (25.50±6.52 Vs 21.29±4.07; p=0.000), and creatinine(185.96±97.20 Vs 92.40±78.13; p=0.000) were significantly lower after HD. About 70% of the participants had hypokaliemia after HD. Plasma
sodium (131±6.92 Vs 126.52±10.18; p=0.000), calcium (69.59±15.56 Vs
95.72±18.84; p=0.000) and bicarbonate (17.24±3.73 Vs 23.68±4.31,p=0.000),
were significantly higher after HD. About 40% of the participants had hypercalcemia after HD. The prevalence of ECG anomalies was very high in peridialysis periods 90%, and about 40% of the abnormalities with occurs during HD were severe. These anomalies where more important during dialysis with a frequency of 68.5% and where essentially represented by disorders of
ventricular rhythm (68.5%) and abnormalities of ST,T (n=10, 45.45%). Ventricular extrasystoles (n=15, 68.2%) and ST- segment depression (n=10; 45.45%) were the main abnormalities recorded. Post dialysis serum potassium and magnesium were lower in patients with ECG abnormalities while serum
calcium and bicarbonate were higher. A change in serum calcium >19meq/l was the only factor associated with rhythm abnormalities while a change in bicarbonate > 5mmol/l was associated with ST-T depression.
Conclusion: We found a high prevalence of ECG abnormalities during the inaugural session of HD in the Yaounde General hospital; Changes in serum calcium and bicarbonate were associated with these disorders. Our results
suggest that correction of electrolyte imbalance before HD initiation and equipment of haemodialysis units with varies bath of calcium /potassium and cardiac monitoring patients for 2hours post HD may improve cardiac
morbidity.
Keywords: electrocardiographic abnormalities, ESRD, haemodialysis, Holter.


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