Detection of Cardiac Disarrhythmia with Patients Post-Haemodialysis in Dialysis Center of General Kirkuk Hospital

Abstract

Background : Cardiovascular disease (CVD) is a most common complication and  cause of death in patients with end stage renal disease (ESRD). Arrhythmias are complications that are frequently observed in patients attending to hemodialysis varies between 17 to 76%. Increased QT intervals dispersion is predisposing to ventricular arrhythmias and sudden cardiac death.Objective : The main objective of the study is to detect the cardiac disarrhythmia with patients at post-hemodialysis  and  to assess the effect of hemodialysis (HD) on corrected QT (QTc) intervals and their dispersions (QTd) in chronic hemodialyzed patients.Methods: A descriptive study a purposive (non-probability) sample of (60) patients were undergoing hemodialysis was carried out at Kirkuk general hospital/ dialysis center, from December 2013 to 28 March  2014.  The study sample consisted of 60 patients undergoing hemodialysis (61.7% males and 38.3% females), whose mean age was 66.79±13.16 years. All of them underwent  electrocardiograms  performed after one dialysis session. On a second phase, ECG was performed pre –post  hemodialysis .12-leads standard ECG were recorded using a Mortara instrument 1246, (USA) electrocardiograph at paper speed of 25 mm/s and 10 mm/mV, and a blood specimen was drawn to measure plasma electrolytes pre –post a single hemodialysis session. Results were tested for normality and expressed as mean ± SD,. Comparisons were made using t test or Mann-Whitney test (electrolyte values).Results :Post-dialysis arrhythmia showed 20(33.3%) of participants are suffer from Sinus bradycardia and 15 (25%) of them are suffer from irregularity with possible premature atrial  contraction. The mean of pre and post dialysis R-R intervals was (780.11±90.75 ms pre-HD vs. 811.16±81.45 post-HD, respectively (p>0.05). The mean of corrected QT cmax intervals increased significantly from 383.11±11.95 msec pre-HD vs. 422.16±18.70  msec post-HD, (p<0.05). The mean of QTc dispersion increases from 47.56±9.85 ms pre-HD to 59.25±11.93 ms post-HD (p<0.05) respectively. The changes in serum potassium and calcium levels were related with QT interval prolongation. a statistical  high  significant difference of  serum Changes ( (Potassium, Calcium, and Urea) at pre-post hemodialysis  with mean± SD (5.09±0.70 vs 3.96±0.54 , 7.34±0.90 vs 7.72±0.60 , 59.88±9.50 vs 21.97±4.81 ) respectively .Conclusions: This study showed that QTc_max and QT dispersion, markers of risk for arrhythmias and sudden death, are elevated in hemodialysis patients, and rise pos-dialysis.QTc interval and dispersion increase in HD patients.

Keywords: Chronic renal disease, Hemodialysis, QT interval, Arrhythmia