Dynamic QT interval analysis in uraemic patients receiving chronic haemodialysis

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Abstract
Objective To analyse the duration of the QT interval and its relationship with heart rate changes in patients with uraemia, before and during haemodialysis. Methods QT and RR intervals were measured automatically using a dedicated algorithm with 24-h Holter recordings in 29 patients (15 women) receiving chronic haemodialysis. QT corrected for heart rate (QTc) and the slope of QT/RR linear regression were calculated. Arterial blood pressure (ABP) was measured before and during haemodialysis. Plasma concentrations of K+, Mg2+ and Ca2+ were assessed before and after haemodialysis. Results ABP decreased significantly from baseline (102.7 ± 11.0 mmHg) during the first (100.6 ± 8.8 mmHg, P< 0.05), second (95.6 ± 10.6 mmHg, P< 0.05), and third (94.9 ± 10.3 mmHg, P< 0.05) hours of haemodialysis. QTc was longer during haemodialysis than during a 4-h period of no dialysis (447 ± 28 ms compared with 429 ± 22 ms, P< 0.001), and increased progressively during haemodialysis, with the greatest value during the last hour of haemodialysis (454 ± 32 ms compared with 426 ± 22 ms, P< 0.001). QT/RR slopes and correlation coefficients were lower during haemodialysis than during the period of no dialysis (0.13 ± 0.08 compared with 0.20 ± 0.07, P< 0.001 and 0.48 ± 0.30 compared with 0.81 ± 0.20, respectively; P< 0.001), suggesting a reduced ability to adapt the QT interval in response to changes in heart rate. The effects of haemodialysis on QT interval and the QT/RR relationship were greater in women than in men. QTc variations during dialysis were not correlated with changes in ABP, but were inversely related to changes in Ca2+ concentration (r2 = 0.35; P = 0.001). Conclusions In patients with uraemia, the haemodialysis session induces a progressive increase in QT interval and modifies its relationship with heart rate. These effects may predispose some individuals to ventricular arrhythmias at the end of and immediately after the haemodialysis session.