From the Guidelines
Dialysis is associated with significant changes in electrocardiogram (EKG) readings, including an increased risk of dysrhythmias, cardiac arrest, and sudden cardiac death (SCD).
Relationship Between Dialysis and EKG Readings
- The risk of dysrhythmias and SCD is higher in patients undergoing dialysis due to factors such as electrolyte imbalances, volume status changes, and underlying cardiovascular disease 1.
- EKG monitoring is recommended for patients undergoing dialysis, particularly those with severe hyperkalemia or metabolic imbalance, or those hospitalized for another condition with a Class I indication for arrhythmia monitoring 1.
- The prevalence of abnormal EKG findings is higher in patients on dialysis, with common findings including left ventricular hypertrophy, evidence of ischemia, premature ventricular contractions, and atrial fibrillation 1.
- Serial changes on EKG can be expected over time in hemodialysis patients, and periodic monitoring of EKGs (e.g., annually) may be appropriate while on a transplant waitlist 1.
- In cases of acute unremitting chest pain during dialysis, a 12-lead EKG should be performed, and the patient should be urgently transferred to an acute care setting for evaluation and further clinical engagement 1.
Clinical Implications
- Patients on maintenance dialysis should have baseline and annual EKGs, as well as continuous EKG monitoring during inpatient dialysis, particularly in the ICU setting 1.
- The high prevalence of abnormal EKG findings in dialysis patients may decrease the utility of standard EKG treadmill testing in this population 1.
From the Research
Relationship Between Dialysis and EKG Readings
The relationship between dialysis and electrocardiogram (EKG) readings is complex and has been studied in various research papers.
- Studies have shown that hemodialysis can cause changes in EKG parameters, including increased QRS duration and QTc interval, and decreased T-wave amplitude 2, 3.
- These changes can be associated with an increased risk of ventricular arrhythmias and sudden cardiac death in patients with end-stage renal disease (ESRD) 2, 4.
- The severity of frailty in dialysis patients has also been found to be associated with EKG findings, including QRS duration 5.
- A comparative study found that EKG conduction intervals were longer in hemodialysis patients compared to peritoneal dialysis patients and those with normal kidney function or chronic kidney disease (CKD) stages 1 and 2 6.
EKG Parameters Affected by Dialysis
Several EKG parameters have been found to be affected by dialysis, including:
- QRS duration: increased in hemodialysis patients compared to pre-dialysis values 2, 3 and associated with frailty severity 5.
- QTc interval: increased in hemodialysis patients compared to pre-dialysis values 2 and associated with an increased risk of ventricular arrhythmias and sudden cardiac death 4.
- T-wave amplitude: decreased in hemodialysis patients compared to pre-dialysis values 2.
- PR interval: longer in hemodialysis patients compared to peritoneal dialysis patients and those with normal kidney function or CKD stages 1 and 2 6.
Clinical Implications
The changes in EKG parameters associated with dialysis can have significant clinical implications, including:
- Increased risk of ventricular arrhythmias and sudden cardiac death 2, 4.
- Need for proactive cardiac evaluations and risk reduction in dialysis patients with abnormal EKG findings 6.
- Importance of monitoring EKG parameters in dialysis patients to identify those at high risk of cardiovascular complications 4.