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Electrocardiogram findings at the initiation of hemodialysis and types of subsequent cardiovascular events

Hypertension Research volume 44, pages 571–580 (2021)Cite this article

Abstract

The prognostic value of electrocardiograms (ECGs) has been reported in predialysis patients but not in incident hemodialysis patients with overhydration and electrolyte disturbances, both of which potentially affect ECG results. We performed a retrospective multicenter cohort study involving incident hemodialysis patients and examined whether ECG parameters immediately before hemodialysis initiation can predict subsequent cardiovascular disease (CVD) using Cox proportional hazards models. We explored potential effect modifications by several electrolytes on the predictive power of ECG abnormalities. Among the 618 enrolled patients, 16%, 10%, 46%, and 22% showed a PR interval ≥ 200 ms, QRS interval ≥120 ms, QTc interval ≥ 450/460 ms (male/female), and left ventricular hypertrophy (LVH) by voltage criteria, respectively. Over a median 3-year follow-up, 19% and 16% of the patients developed atherosclerotic and nonatherosclerotic CVD, respectively. The Cox regression model results revealed that the sum of the number of abnormalities in PR, QRS, and QT intervals was a significant risk factor for nonatherosclerotic CVD (hazard ratios (HRs) [95% confidence interval (CI)]: 1.58 [1.24–2.01] per number of abnormalities). The predictive value of LVH for atherosclerotic CVD was attenuated over time. At up to 36 months, although the proportional hazards assumption was met, LVH was significantly associated with atherosclerotic CVD (HR [95% CI]: 1.89 [1.15–3.11]). The adjusted HR was particularly high (HR [95% CI]: 4.02 [1.68–9.60]) among patients who were in the lowest tertile of serum magnesium levels (P for interaction = 0.04). PR, QRS, and QT prolongation additively predicted nonatherosclerotic CVD, while LVH predicted atherosclerotic CVD in the short term.

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Acknowledgements

We thank Dr. Shihomi Maeda, Dr. Fumiyuki Morioka, Dr. Syou Matsui, Dr. Sayaka Katou, Dr. Akane Ito, Dr. Eriko Iwahashi, (JCHO Osaka Hospital), Dr. Kiyoshi Shozu (Aino Hospital), Dr. Yutaro Azuma (Azuma Dialysis Clinic), Dr. Akira Wada (Azuma Renal Clinic), Dr. Jong Il Kim (Chibune Kidney and Dialysis Clinic), Dr. Sachiko Yamada (Saiseikai Ibaraki Hospital), Dr. Yasuhiro Enomoto (Enomoto Clinic), Dr. Ryoichi Miyazaki (Fujita Memorial Hospital), Dr. Yuji Murata (Harbor-Town Clinic), Dr. Toshiaki Hirabayashi (Heimeikai Clinic), Dr. Fukuhara Isao (Heisei Urologic Clinic), Dr. Shigeru Yamaguchi (Hokusetsu General Hospital), Dr. Takashi Tomokuni (Ibaraki Iseikai Hospital), Dr. Toyohumi Fukuda (Ibuki Clinic), Dr. Kazuyuki Hayashi (Ikeda Municipal Hospital), Dr. Nobuyuki Imai (Imai Naika Clinic), Dr. Yasuji Kuroda (Inadera Dialysis Clinic), Dr. Yuko Fujiwara, Dr. Yoshihiro Tsujimoto (Inoue Hospital), Dr. Takahisa Hotta (Iseikai Fuzoku Clinic), Dr. Takahiro Fujii (Itami Bara Clinic), Dr. Tomoko Yokokawa (Itami Gardens Clinic), Dr. Kazuo Yasuda (Jinyuukai Yasuda Clinic), Dr. Masanori Joko (Joko Clinic), Dr. Yukiomi Namba (Jouto Iseikai Clinic), Dr. Jyunya Takahara (Takahara Clinic), Dr. Mayumi Sakurai (Jyurakukai Clinic), Dr. Masato Baden (Kaiseikai Takarazuka Hospital), Dr. Hisato Nakamori (Katano Hospital), Dr. Hironori Kawamura (Kawamura Clinic), Dr. Chikako Monden (Kisei Hospital), Dr. Ken Kishida (Kishida Clinic), Dr. Eikun Maruyama (Kitagawa Clinic), Dr. Fumi Sato (KKR Otemae Hospital), Dr. Shigeru Hanada (Koseikai Taisei Clinic), Dr. Akihisa Kuki (Kuki Clinic), Dr. Takayuki Okamoto (Kyoritsu Hospital), Dr. Mitsuru Kubo (Kyowakai Hospital), Dr. Haruki Fuse (Maizuru Kyosai Hospital), Dr. Yutaka Matsui (Matsui Dietary & Dementia Clinic), Dr. Noriko Mikami (Mikami Clinic), Dr. Hiroshi Miyao (Miyo Urology Clinic), Dr. Mutsuko Mori (Mori Clinic), Dr. Rumi Sakai (Motoyama Sakai Rumi Clinic), Dr. Shunro Agata (Nagahara Hospital), Dr. Takanori Nagai (Nagai Clinic), Dr. Hideyuki Nakagawa (Nakagawa Clinic), Dr. Masashi Shinozaki (Nakano Clinic), Dr. Yasuo Ohyama (Neyagawa Keijinkai Clinic), Dr. Kanji Nozaki (Nozaki Clinic), Dr. Tetsuya Kaneko (NTT West Osaka Hospital), Dr. Takeshi Omichi (Ohmichi Clinic), Dr. Motohiro Okamura (Okamuraiin Jin Clinic), Dr. Akira Okasho (Okasho Urology Clinic), Dr. Kiyoshi Goto (Ono-Naika Clinic), Dr. Hidekazu Shimizu (Onoyama Clinic), Dr. Masahiro Kyo (Osaka Umeda Iseikai Dialysis Clinic), Dr. Nobuhiko Narukawa (Sakuragaoka Hospital), Dr. Kei Hirai (Sanko Clinic), Dr. Kazuhisa Yamamoto (Sanko Hospital), Dr. Satoshi Sasaki (Sasaki Medical Clinic), Dr. Masugi Satoh (Satoh Clinic Kuzuha), Dr. Daisuke Nakagawa (Second Rokushima Clinic), Dr. Hiroyuki Araki (Settsu Iseikai Hospital), Dr. Shintaro Yamanaka (Shingu Municipal Medical Center), Dr. Atsushi Yokota (Shin-Osaka Iseikai Clinic), Dr. Ken Takahara (Sone Hospital), Dr. Zenzo Fujii (St. Hill Hospital), Dr. Jun Matsuda (Suita City Hospital), Dr. Yoshinori Sai (Suminodo Clinic), Dr. Kanji Yoshida (Suzawa Clinic), Dr. Tadashi Hatayama (Neyagawaikunobyouinn), Dr. Yukito Kokado, Dr. Tohru Takahashi (Takahashi Clinic), Dr. Kazuyuki Takahashi (Takahashi Kazuyuki Clinic), Dr. Yoshiaki Hirosue (Takasago Municipal Hospital), Dr. K.Y. (Tanaka Clinic), Dr. Masatou Tanaka (Tanaka Urology Clinic Dialysis Center Furuedai), Dr. Hiroko Tokizane (Tokizane Clinic), Dr. Keiji Isshiki (Tomita Clinic), Dr. Jun Tomita (Toyonaka Watanabe Clinic, Kansai Medical Hospital), Dr. Yumiko Honda (Toyonakamidorigaoka Hospital), Dr. Takahide Sugiyama (Tsukuno Fujii Clinic), Dr. Akira Moriguchi (Umeda-Higashi Blood Purification Clinic), Dr. Takatoshi Yamamoto (Yamamoto Clinic), Dr. Masaru Shin (Yao Tokushukai General Hospital), and Dr. Toru Yoshie (Yoshie Hospital) for their assistance in collecting data.

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Authors and Affiliations

  1. Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan

    Satoshi Yamaguchi, Takayuki Hamano, Tatsufumi Oka, Yohei Doi, Sachio Kajimoto, Seiichi Yasuda, Karin Shimada, Ayumi Matsumoto, Kazunori Inoue, Isao Matsui & Yoshitaka Isaka

  2. Department of Internal Medicine, Japan Community Health care Organization Osaka Hospital, Osaka, Japan

    Satoshi Yamaguchi & Akira Suzuki

  3. Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Takayuki Hamano

  4. Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Suita, Japan

    Yusuke Sakaguchi

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  1. Satoshi Yamaguchi
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Yamaguchi, S., Hamano, T., Oka, T. et al. Electrocardiogram findings at the initiation of hemodialysis and types of subsequent cardiovascular events. Hypertens Res 44, 571–580 (2021). https://doi.org/10.1038/s41440-020-00592-z

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