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Abstract: FR-PO401

Electrocardiogram Findings at the Initiation of Hemodialysis and Types of Future Cardiovascular Events

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Yamaguchi, Satoshi, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
  • Hamano, Takayuki, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
  • Doi, Yohei, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
  • Oka, Tatsufumi, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
  • Sakaguchi, Yusuke, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
  • Matsui, Isao, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
  • Suzuki, Akira, Japan Community Health Care Organization Osaka Hospital, Osaka, OSAKA-FU, Japan
  • Isaka, Yoshitaka, Osaka University Graduate School of Medicine, Suita, OSAKA-FU, Japan
Background

Prognostic value of electrocardiogram (ECG) was reported in pre-dialysis patients. However, it remains to be revealed in hemodialysis (HD) patients. Since incident HD patients suffer from volume overload and electrolyte abnormalities, ECG at the initiation of HD is thought to be a kind of “stress ECG test”.

Methods

We performed a retrospective multicenter cohort study of incident HD patients. We collected the latest data just before the initiation of HD. The primary outcome was atherosclerotic and non-atherosclerotic cardiovascular diseases (CVD) after the initiation of HD. Using Cox proportional hazards models, we examined whether ECG parameters (PR, QRS, QT interval, heart rate, and left ventricular hypertrophy [LVH] by voltage criteria) predict the primary outcome.

Results

Among the enrolled 683 patients, 21 and 16% of the patients showed LVH and PR interval >200 ms (PR prolongation), respectively. Serum phosphate levels were positively associated with heart rate and PR interval (Figure). Over a median follow-up period of 3 years, 19 and 16% of the patients developed atherosclerotic and non-atherosclerotic CVD, respectively. Backward stepwise multivariate Cox regression models including ECG parameters and baseline characteristics of patients revealed that LVH predicted atherosclerotic CVD (hazard ratio [95% CI: Confidence Interval]): 1.96 [1.24-3.11]). In contrast, PR prolongation was a significant risk factor of non-atherosclerotic CVD (hazard ratio [95%CI]: 2.00 [1.17-3.42]).

Conclusion

LVH and PR prolongation were significant risk factors of atherosclerotic and non-atherosclerotic CVD, respectively. Fibroblast growth factor 23 might explain the positive association of serum phosphate levels with heart rate and PR interval.