Skip to main content
PMC home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 2002 May;78(919):273–275. doi: 10.1136/pmj.78.919.273

Changes in the corrected QT interval and corrected QT dispersion during haemodialysis

M Howse 1, S Sastry 1, G Bell 1
PMCID: PMC1742352  PMID: 12151568

Abstract

The link between increased QT dispersion and cardiac death in subjects with diabetes and arterial disease is well recognised. Corrected QT dispersion was studied in subjects with end stage renal failure on haemodialysis. Thirty one stable, chronic subjects on haemodialysis had 12-lead electrocardiograms (ECGs) taken before and after a single haemodialysis session. The QT interval was measured manually in each and the corrected QT and corrected QT dispersion calculated. Serum concentrations of potassium, calcium, and magnesium were measured at the same time as ECG acquisition. Corrected QT dispersion increased from a mean (SEM) 90.6 (5.8) to 117.7 (10.2) ms (p=0.002). Serum potassium and magnesium decreased from 5.0 (0.14) to 3.5 (0.09) mmol/l and 0.95 (0.04) to 0.89 (0.09) mmol/l respectively, while serum calcium increased from 2.56 (0.04) to 2.77 (0.04) mmol/l. Intradialytic weight fell by a mean of 2.1 kg. There was no significant correlation between the change in QTc dispersion and the changes in measured serum anions or the subjects' weight during dialysis. Corrected QT dispersion was higher in subjects on haemodialysis than previously suggested normal values, and was significantly increased by haemodialysis. This reflects increased inhomogeneous ventricular repolarisation, which may lead to an increased risk of arrhythmias and sudden death. Studies looking at QT dispersion in subjects on dialysis should standardise the timing of ECG recordings taken with respect to dialysis.

Full Text

The Full Text of this article is available as a PDF (99.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abe S., Yoshizawa M., Nakanishi N., Yazawa T., Yokota K., Honda M., Sloman G. Electrocardiographic abnormalities in patients receiving hemodialysis. Am Heart J. 1996 Jun;131(6):1137–1144. doi: 10.1016/s0002-8703(96)90088-5. [DOI] [PubMed] [Google Scholar]
  2. Barr C. S., Naas A. A., Fenwick M., Struthers A. D. Enalapril reduces QTc dispersion in mild congestive heart failure secondary to coronary artery disease. Am J Cardiol. 1997 Feb 1;79(3):328–333. doi: 10.1016/s0002-9149(96)00756-4. [DOI] [PubMed] [Google Scholar]
  3. Blumberg A., Häusermann M., Strub B., Jenzer H. R. Cardiac arrhythmias in patients on maintenance hemodialysis. Nephron. 1983;33(2):91–95. doi: 10.1159/000182919. [DOI] [PubMed] [Google Scholar]
  4. Cui G., Sen L., Sager P., Uppal P., Singh B. N. Effects of amiodarone, sematilide, and sotalol on QT dispersion. Am J Cardiol. 1994 Nov 1;74(9):896–900. doi: 10.1016/0002-9149(94)90582-7. [DOI] [PubMed] [Google Scholar]
  5. Cupisti A., Galetta F., Morelli E., Tintori G., Sibilia G., Meola M., Barsotti G. Effect of hemodialysis on the dispersion of the QTc interval. Nephron. 1998;78(4):429–432. doi: 10.1159/000044972. [DOI] [PubMed] [Google Scholar]
  6. Darbar D., Luck J., Davidson N., Pringle T., Main G., McNeill G., Struthers A. D. Sensitivity and specificity of QTc dispersion for identification of risk of cardiac death in patients with peripheral vascular disease. BMJ. 1996 Apr 6;312(7035):874–879. doi: 10.1136/bmj.312.7035.874. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Davey P. P., Bateman J., Mulligan I. P., Forfar C., Barlow C., Hart G. QT interval dispersion in chronic heart failure and left ventricular hypertrophy: relation to autonomic nervous system and Holter tape abnormalities. Br Heart J. 1994 Mar;71(3):268–273. doi: 10.1136/hrt.71.3.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gang Y., Guo X. H., Crook R., Hnatkova K., Camm A. J., Malik M. Computerised measurements of QT dispersion in healthy subjects. Heart. 1998 Nov;80(5):459–466. doi: 10.1136/hrt.80.5.459. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Higham P. D., Campbell R. W. QT dispersion. Br Heart J. 1994 Jun;71(6):508–510. doi: 10.1136/hrt.71.6.508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Higham P. D., Furniss S. S., Campbell R. W. QT dispersion and components of the QT interval in ischaemia and infarction. Br Heart J. 1995 Jan;73(1):32–36. doi: 10.1136/hrt.73.1.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Jackman W. M., Friday K. J., Anderson J. L., Aliot E. M., Clark M., Lazzara R. The long QT syndromes: a critical review, new clinical observations and a unifying hypothesis. Prog Cardiovasc Dis. 1988 Sep-Oct;31(2):115–172. doi: 10.1016/0033-0620(88)90014-x. [DOI] [PubMed] [Google Scholar]
  12. Kirvelä M., Yli-Hankala A., Lindgren L. QT dispersion and autonomic function in diabetic and non-diabetic patients with renal failure. Br J Anaesth. 1994 Dec;73(6):801–804. doi: 10.1093/bja/73.6.801. [DOI] [PubMed] [Google Scholar]
  13. Lorincz I., Mátyus J., Zilahi Z., Kun C., Karányi Z., Kakuk G. QT dispersion in patients with end-stage renal failure and during hemodialysis. J Am Soc Nephrol. 1999 Jun;10(6):1297–1302. doi: 10.1681/ASN.V1061297. [DOI] [PubMed] [Google Scholar]
  14. Mall G., Rambausek M., Neumeister A., Kollmar S., Vetterlein F., Ritz E. Myocardial interstitial fibrosis in experimental uremia--implications for cardiac compliance. Kidney Int. 1988 Apr;33(4):804–811. doi: 10.1038/ki.1988.71. [DOI] [PubMed] [Google Scholar]
  15. Moreno F. L., Villanueva T., Karagounis L. A., Anderson J. L. Reduction in QT interval dispersion by successful thrombolytic therapy in acute myocardial infarction. TEAM-2 Study Investigators. Circulation. 1994 Jul;90(1):94–100. doi: 10.1161/01.cir.90.1.94. [DOI] [PubMed] [Google Scholar]
  16. Morris S. T., Galiatsou E., Stewart G. A., Rodger R. S., Jardine A. G. QT dispersion before and after hemodialysis. J Am Soc Nephrol. 1999 Jan;10(1):160–163. doi: 10.1681/ASN.V101160. [DOI] [PubMed] [Google Scholar]
  17. Port F. K. Morbidity and mortality in dialysis patients. Kidney Int. 1994 Dec;46(6):1728–1737. doi: 10.1038/ki.1994.475. [DOI] [PubMed] [Google Scholar]
  18. Ramirez G., Brueggemeyer C. D., Newton J. L. Cardiac arrhythmias on hemodialysis in chronic renal failure patients. Nephron. 1984;36(4):212–218. doi: 10.1159/000183156. [DOI] [PubMed] [Google Scholar]
  19. Ritz E., Rambausek M., Mall G., Ruffmann K., Mandelbaum A. Cardiac changes in uraemia and their possible relationship to cardiovascular instability on dialysis. Nephrol Dial Transplant. 1990;5 (Suppl 1):93–97. doi: 10.1093/ndt/5.suppl_1.93. [DOI] [PubMed] [Google Scholar]
  20. Rombolà G., Colussi G., De Ferrari M. E., Frontini A., Minetti L. Cardiac arrhythmias and electrolyte changes during haemodialysis. Nephrol Dial Transplant. 1992;7(4):318–322. doi: 10.1093/oxfordjournals.ndt.a092135. [DOI] [PubMed] [Google Scholar]
  21. Sforzini S., Latini R., Mingardi G., Vincenti A., Redaelli B. Ventricular arrhythmias and four-year mortality in haemodialysis patients. Gruppo Emodialisi e Patologie Cardiovascolari. Lancet. 1992 Jan 25;339(8787):212–213. doi: 10.1016/0140-6736(92)90008-q. [DOI] [PubMed] [Google Scholar]
  22. Zabel M., Koller B. S., Sachs F., Franz M. R. Stretch-induced voltage changes in the isolated beating heart: importance of the timing of stretch and implications for stretch-activated ion channels. Cardiovasc Res. 1996 Jul;32(1):120–130. [PubMed] [Google Scholar]
  23. Zabel M., Portnoy S., Franz M. R. Electrocardiographic indexes of dispersion of ventricular repolarization: an isolated heart validation study. J Am Coll Cardiol. 1995 Mar 1;25(3):746–752. doi: 10.1016/0735-1097(94)00446-W. [DOI] [PubMed] [Google Scholar]
  24. Zuber M., Steinmann E., Huser B., Ritz R., Thiel G., Brunner F. Incidence of arrhythmias and myocardial ischaemia during haemodialysis and haemofiltration. Nephrol Dial Transplant. 1989;4(7):632–634. [PubMed] [Google Scholar]
  25. van de Loo A., Arendts W., Hohnloser S. H. Variability of QT dispersion measurements in the surface electrocardiogram in patients with acute myocardial infarction and in normal subjects. Am J Cardiol. 1994 Dec 1;74(11):1113–1118. doi: 10.1016/0002-9149(94)90462-6. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES