Electrocardiography is Unreliable to Detect Potential Lethal Hyperkalemia in Patients with Non-dialysis Chronic Kidney Disease.

Autor: Assadi F; Department of Pediatrics, Division of Nephrology, Children Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran. farahnak_assadi@rush.edu.; Department of Pediatrics, Division of Nephrology, Rush University Medical Center, 445 East North Water Street, Suite 1804, Chicago, IL, USA. farahnak_assadi@rush.edu., Mazaheri M; Department of Pediatrics, Section of Nephrology, Semnan University of Medical Sciences, Semnan, Iran., Rad EM; Department of Pediatrics, Division of Cardiology, Children Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
Jazyk: angličtina
Zdroj: Pediatric cardiology [Pediatr Cardiol] 2022 Jun; Vol. 43 (5), pp. 1064-1070. Date of Electronic Publication: 2022 Apr 07.
DOI: 10.1007/s00246-022-02826-y
Abstrakt: Hemodialysis patients with hypercalcemia are less likely to manifest the usual electrocardiographic changes associated with hyperkalemia than in those with normal renal function. This study was conducted to determine whether electrocardiography (ECG) is a reliable indicator to detect severe life-threatening hyperkalemia in non-dialysis CKD patients. The study was conducted at three referral university hospitals between July 2017 and June 2018. Severe hyperkalemia was defined as serum potassium concentration ≥ 8.0 mEq/L. Serum potassium, sodium, bicarbonate, calcium, and creatinine concentrations were measured and simultaneous 12-lead ECG was obtained. Patients with end-stage renal disease receiving renal replacement therapy were excluded. Also excluded were patients with the usual ECG abnormalities to hyperkalemia. Of the 438 patients screened, 10 (2.3%) aged 2-14 years with severe hyperkalemia and normal ECG findings were identified. Median serum potassium level was 8.6 mEq/L (range 8.2-9.0). All had regular sinus rhythm. P, QRS, ST segment, T morphology, PR and QT interval, and QRS duration were all normal. Hyperkalemia was associated with CKD, metabolic acidosis, and hypercalcemia in all cases. Therapy with intravenous 0.9% saline, sodium bicarbonate, glucose, insulin, calcium, and salbutamol corrected the hyperkalemia in 7 patients. The remaining three patients evinced arrhythmias requiring hemodialysis. Although rare, non-dialysis CKD patients with hypercalcemia may not manifest the usual electrographic abnormalities associated with hyperkalemia. Thus, a normal ECG finding in non-dialysis CKD patients should be interpreted with caution.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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