Electrophysiologic substrate and risk of mortality in incident hemodialysis

Larisa G. Tereshchenko, Esther D. Kim, Andrew Oehler, Lucy A. Meoni, Elyar Ghafoori, Tejal Rami, Maggie Maly, Muammar Kabir, Lauren Hawkins, Gordon F. Tomaselli, Joao A. Lima, Bernard G. Jaar, Stephen M. Sozio, Michelle Estrella, W. H.Linda Kao, Rulan S. Parekh

Research output: Contribution to journalArticle

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Abstract

The single leading cause of mortality on hemodialysis is sudden cardiac death. Whether measures of electrophysiologic substrate independently associate with mortality is unknown. We examined measures of electrophysiologic substrate in a prospective cohort of 571 patients onincident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage RenalDisease Study. A total of 358 participants completed both baseline 5-minute and 12-lead electrocardiogram recordings on a nondialysis day. Measures of electrophysiologic substrate included ventricular late potentials by the signal-Averaged electrocardiogram and spatial mean QRS-T angle measured on the averaged beat recorded within a median of 106 days (interquartile range, 78-151 days) from dialysis initiation. The cohort was 59% men, and 73% were black, with a mean±SD age of 55613 years. Transthoracic echocardiography revealed a mean±SD ejection fraction of 65.5%612.0% and a mean±SDleft ventricularmass index of 66.6622.3 g/m2.7. During 864.6 person-years of follow-up, 77 patients died; 35 died fromcardiovascular causes, of which 15 were sudden cardiac deaths. By Cox regression analysis, QRS-T angle ≥75° significantly associated with increased risk of cardiovascular mortality (hazard ratio, 2.99; 95% confidence interval, 1.31 to 6.82) and sudden cardiac death (hazard ratio, 4.52; 95% confidence interval, 1.17 to 17.40) after multivariable adjustment for demographic, cardiovascular, and dialysis factors. Abnormal signal-Averaged electrocardiogram measures did not associate with mortality. In conclusion, spatial QRS-T angle but not abnormal signal-Averaged electrocardiogram significantly associates with cardiovascular mortality and sudden cardiac death independent of traditional risk factors in patients starting hemodialysis.

Original languageEnglish (US)
Pages (from-to)3413-3420
Number of pages8
JournalJournal of the American Society of Nephrology
Volume27
Issue number11
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Sudden Cardiac Death
Renal Dialysis
Electrocardiography
Mortality
Dialysis
Confidence Intervals
Echocardiography
Regression Analysis
Demography

ASJC Scopus subject areas

  • Nephrology

Cite this

Tereshchenko, L. G., Kim, E. D., Oehler, A., Meoni, L. A., Ghafoori, E., Rami, T., ... Parekh, R. S. (2016). Electrophysiologic substrate and risk of mortality in incident hemodialysis. Journal of the American Society of Nephrology, 27(11), 3413-3420. https://doi.org/10.1681/ASN.2015080916

Electrophysiologic substrate and risk of mortality in incident hemodialysis. / Tereshchenko, Larisa G.; Kim, Esther D.; Oehler, Andrew; Meoni, Lucy A.; Ghafoori, Elyar; Rami, Tejal; Maly, Maggie; Kabir, Muammar; Hawkins, Lauren; Tomaselli, Gordon F.; Lima, Joao A.; Jaar, Bernard G.; Sozio, Stephen M.; Estrella, Michelle; Kao, W. H.Linda; Parekh, Rulan S.

In: Journal of the American Society of Nephrology, Vol. 27, No. 11, 01.01.2016, p. 3413-3420.

Research output: Contribution to journalArticle

Tereshchenko, LG, Kim, ED, Oehler, A, Meoni, LA, Ghafoori, E, Rami, T, Maly, M, Kabir, M, Hawkins, L, Tomaselli, GF, Lima, JA, Jaar, BG, Sozio, SM, Estrella, M, Kao, WHL & Parekh, RS 2016, 'Electrophysiologic substrate and risk of mortality in incident hemodialysis', Journal of the American Society of Nephrology, vol. 27, no. 11, pp. 3413-3420. https://doi.org/10.1681/ASN.2015080916
Tereshchenko, Larisa G. ; Kim, Esther D. ; Oehler, Andrew ; Meoni, Lucy A. ; Ghafoori, Elyar ; Rami, Tejal ; Maly, Maggie ; Kabir, Muammar ; Hawkins, Lauren ; Tomaselli, Gordon F. ; Lima, Joao A. ; Jaar, Bernard G. ; Sozio, Stephen M. ; Estrella, Michelle ; Kao, W. H.Linda ; Parekh, Rulan S. / Electrophysiologic substrate and risk of mortality in incident hemodialysis. In: Journal of the American Society of Nephrology. 2016 ; Vol. 27, No. 11. pp. 3413-3420.
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