Elektrokardiografi dan Kalium Serum Sebelum dan Sesudah Hemodialisis

Abstract

Background : Potassium concentration, especially hyperkalemia, has a strong influence on Electrocmdiography (ECG) and particularly on T-wave morphology. It is speculated, but unconfirmed, that the usual elechocardiographic manifestations of hyperkalemia are less frequent and less pronounced in persons with chronic kidney disease (CKD) than in those with normal renal fimction. The aim of the study was to assess potassium level, by serum or bioelectrical impedance analysis (BIA), and ECG changes post hemodialysis (HD) and whether fall in potassium level that made ECG changes during HD may predict arrhythmogenic event in CKD patients on HD. Methods : This is a quasi experimental study. We studied 5l CKD patients on HD who had their serum electrolytes measured (sodium, potassium, chloride and calcium), BIA and ECG immediately pre and post HD. Results : The 51 subject comprised 34 men (66.7 and 17 women (33.3%) wirh mean (+ SD) of age 45.80 + 12.22 years old. Mean of serum potassium decreased post HD from 4.84 + 0.83 mEq/L to 3.52 + 0.76 mEq/L (p = 0.0001) and mean of rotal body potassium (TBK) decreased post HD from 112.68 + 23.23 gram to 109.99 + 22.33 gram (p: 0.0001). ECG parameters significantly changed post HD. The T wave arnplitude and T to R wave mtio (T/R ratio) decreased significantly (p = 0.0001), these changes may have an anhythmogenic potential. T to R wave ratio is more specilic and more sensitive than T wave amplitude or QTc interval in recognizing repolarization changes caused by potassium changes. Conclusions : Potassium, TBK, T wave amplitude and T to R wave amplitude significanfly decreased post HD. Post HD serum potassium decrement had sigrificantly correlation with QRS duration and a decrcase in T to R wave ratio on ECG, while post HD TBK decrement had significantly cotrelation with T wave amplitude and a decrease in T to R wav€ Ertio on ECG.T lo R wave ratio is more specific and more sensitive than T wave amplitude and QTc interval for potassium.