Electrocardiographic changes in patients with chronic kidney disease starting renal replacement therapy
Keywords:
chronic renal disease, renal dialysis, electrocardiography, hyperkalemia, left ventricular hyperthrophyAbstract
Introduction: cardiovascular complications are the leading causes of death in patients with chronic kidney disease from stages 2 or 3 to stage 5 (end stage renal disease), accounting for about 50% of deaths in this group of patients. The disease in stage 5 is characterized by glomerular filtration rate lower than 15 mL/min/1.73m² and its main causes are hypertension and Diabetes mellitus type 2. Objective: to describe the changes electrocardiography of patients with chronic kidney disease stage 5 at the moment they start dialysis and correlate them with the underlying disease that caused chronic kidney disease. Results: the electrocardiograms of 199 patients from a single dialysis center in a four-year period were evaluated. Most patients have chronic kidney disease caused by Diabetes mellitus type 2 (36.5%), hypertension (30%) and glomerulopathies (12%). We observed only 12% of electrocardiographic exams with normal tracing. The most common changes were the left atrial enlargement (31%), left ventricular hypertrophy (30%), altered ventricular depolarization by hyperkalemia (26%) and QTc prolonged interval. Left ventricular hypertrophy was more prevalent in patients with hypertension as a cause of chronic kidney disease and the strain fairly common pattern (47% of cases with left ventricular hypertrophy). Conclusion: the electrocardiographic changes are very prevalent in patients with stage 5 chronic kidney disease and must be known by the professionals who take care of them.
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Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C-Y. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296-305.
Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004;164:659-63.
Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Prim Care. 2008;35:329-43.
Bucharles SGE, Varela AM, Barberato SH, Pecoits-Filho R. Avaliação e manejo da doença cardiovascular em pacientes com doença renal crônica. J Bras Nefrol. 2010;32:120-7.
D’Ávila R, Guerra EMM, Rodrigues CIS, Fernandes FA, Cadaval RAM, Almeida FA. Sobrevida de pacientes renais crônicos em diálise peritoneal e hemodiálise. J Bras Nefrol. 1999;21:13-21.
Sesso R, Gordon P. Dados disponíveis sobre a doença renal crônica no Brasil. J Bras Nefrol. 2007;29(supl 1):9-12.
Sesso RC, Lopes AA, Thomé FS, Lugon JR, Santos DR. 2010 Report of the Brazilian Dialysis Census. J Bras Nefrol. 2011;33:442-7.
Longenecker JC, Coresh J, Powe NR, Levey AS, Fink NE, Martim A, Klag MJ. Traditional cardiovascular disease risk factors in dialysis patients compared with the general population: The CHOICE Study. J Am Soc Nephrol. 2002;13:1918–27.
Shastri S, Sarnak MJ. Cardiovascular disease and CKD: core curriculum. Am J Kidney Dis. 2010;56:399-417.
Abe S, Yoshizawa M, Nakanishi N, Yazawa T, Yokota K, Honda M, et al. Electrocardiographic abnormalities in patients receiving hemodialysis. Am Heart J. 1996;131:1137-44.
Tun A, Khan IA, Wattanasauwan N, Win MT, Hussain A, Hla TA, Cherukuri VL,Vasavada BC, Sacchi TJ. Increased regional and transmyocardial dispersion of ventricular repolarization in end-stage renal disease. Can J Cardiol. 1999;15:53-6.
Bignotto LH, Kallás ME, Djouki RJT, Sassaki MM, Voss GO, Soto CL, Fr a t t ini F, Mede i ros FSR. Achados eletrocardiográficos em pacientes com doença renal crônica em hemodiálise. J Bras Nefrol. 2012;34:235-42.
Hage FG, Mattos AM, Khamash H, Mehta S, Warnock D, Iskandrian AE.QT prolongation is an independent predictor of mortality in end-stage renal disease. Clin Cardiol. 2010;33:361-6.
Green D, Roberts PR, New DI, Kalra PA. Sudden cardiac death in hemodialysis patients: an in-depth review. Am J Kidney Dis. 2011;57:921-9.
Costa FA, Rivera IR, Vasconcelos ML, Costa AF, Póvoa RM, Bombig MT, et al. Electrocardiography in the diagnosis of ventricular hypertrophy in patients with chronic renal disease. Arq Bras Cardiol. 2009;93:380-6.
Diretrizes da Sociedade Brasileira de Cardiologia sobre Análise e Emissão de Laudos Eletrocardiográficos (2009). Arq Bras Cardiol. 2009;93(3 supl. 2):1-19.
MedCalc: easy-to-use statistical software [Internet]. Version 14.12.0. Ostend: MedCalc; c1993-2015 [acesso em 02 nov . 2014]. Disponível em: http://www.medcalc.org/manual/comparison_of_proportions.php.
Algra A, Tijssen JG, Roelandt JR, Pool J, Lubsen J. QTc prolongation measured by standard 12-lead electrocardiography is an independent risk factor for sudden death due to cardiac arrest. Circulation. 1991;83:1888-94.
Valadares RM, Vescovi CC, Neri HG, Campos NB, Rodrigues CIS, Cadaval RAM, Almeida FA. Características clínicas e epidemiológicas do paciente portador de diabetes mellitus (DM) que inicia terapia renal substitutiva. X Encontro Paulista de Nefrologia, 2005, Campos do Jordão. J Bras Nefrol. 2005; 27(supl.):S73.
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