Electrocardiographic manifestations of hyperkalemia in hemodialysis patients

This study was performed to evaluate whether any electrocardiogram (ECG) para­meter can predict the presence of hyperkalemia in patients on maintenance hemodialysis (HD). In January 2006, we conducted a cross-sectional study of 80 stable patients with end-stage renal disease from four university-based HD units of Tehran, Iran, receiving conventional thrice-weekly HD. Pre-HD serum electrolyte values and conventional 12-lead ECG were obtained from each pa­tient. Bivariate linear regression was used for assessing relationship of the study variables with hyperkalemia (K + 5.2 mg/dL). Multivariable logistic regression was used for evaluating inde­pendent relationship between decreased T wave duration (? 170 ms) and other variables. Bivariate correlation analysis showed a significant inverse correlation between serum potassium concentra­tion and T wave duration (P 0.05). None of the patients with serum potassium of ? 5.6 mg/dL had T wave duration 200 ms. Multivariate logistic analysis, after adjustment for other factors, also showed a significant relationship between decreased T wave duration (? 170 ms) and hyper­kalemia. We conclude that although hyperkalemia does not induce the usual ECG changes in HD patients, decreased T wave duration was found to be a good indicator of this lethal condition.