From the Guidelines
Uremia is strongly associated with abnormal electrocardiogram (EKG) findings, including left ventricular hypertrophy, evidence of ischemia, and non-specific ST-T changes.
EKG Findings in Uremia
- The prevalence of abnormal EKG findings is higher in patients with advanced kidney failure, with a study by Abe et al 1 showing that 65% of patients on long-term hemodialysis had abnormal EKG findings.
- Common EKG findings in uremic patients include left ventricular hypertrophy (19%), evidence of ischemia (7.2%), premature ventricular contractions (6.8%), and non-specific ST-T changes (6%) 1.
- Uremic pericarditis, a condition associated with renal failure, can also lead to abnormal EKG findings, although the EKG may not show typical diffuse ST/T wave elevations observed with other causes of acute pericarditis 1.
Clinical Implications
- The presence of abnormal EKG findings in uremic patients can be a predictor of overall risk stratification, and it is recommended to obtain a baseline EKG in all renal transplantation candidates 1.
- Serial changes on EKG in hemodialysis patients can be expected over time, and periodic monitoring of EKGs (e.g., annually) while on a transplant waitlist may be appropriate 1.
- The high prevalence of abnormal EKG findings in uremic patients highlights the importance of careful cardiac evaluation and management in this population.
From the Research
Relationship between Uremia and EKG Findings
The relationship between uremia and electrocardiogram (EKG) findings is complex and multifaceted. Several studies have investigated this relationship, revealing various EKG abnormalities associated with uremia.
- EKG Abnormalities: Studies have shown that uremic patients often exhibit EKG abnormalities, including left ventricular hypertrophy (LVH) 2, 3, 4, QT interval prolongation 4, and arrhythmias 2, 4.
- Uremic Cardiomyopathy: Uremic cardiomyopathy is a condition characterized by left ventricular dysfunction and hypertrophy, which is common in patients with end-stage renal disease (ESRD) 3, 5, 4. EKG findings, such as microvolt T-wave alternans, have been associated with uremic cardiomyopathy 5.
- Risk Factors: Several risk factors have been identified as contributing to the development of cardiac disease in uremic patients, including hypertension 3, anemia 3, and hypoalbuminemia 3.
- Dialysis and EKG Findings: Dialysis has been shown to affect EKG findings, with studies demonstrating a progressive prolongation of the PQ interval in relation to the duration of hemodialysis 2.
- Clinical Implications: The EKG findings associated with uremia have important clinical implications, as they may indicate an increased risk of cardiac complications, such as sudden cardiac death 5, 4.