THE INFLUENCE OF LABORATORY AND ECHOCARDIOGRAPHY PARAMETERS ON WAVE P AT PATIENTS WITH END-STAGE KIDNEY DISEASE

AIM – To define the factors influencing on the duration and the dispersion of wave Р at patients with end-stage kidney disease (ESKD), receiving therapy by hemodialysis (HD) and permanent ambulatory peritoneal dialysis (PAPD). PATIENTS AND METHODS. The research included 22 patients with ESKD, receiving HD, 21 patient receiving PAPD, 20 patients with chronic kidney disease (CKD), not receiving treatment by renal replacement therapy (control group). All patients were executed a complex of laboratory analyses, an echocardiography and an electrocardiography in 12 assignments. By results of electrocardiography maximum duration of wave Р and dispersion of wave P were estimated. RESULTS. Patients receiving HD therapy, received authentic interrelations between duration of wave Р and age (r=0,58), Kt/V (r =–0,44), pH (r=0,45), size of left atrium (LA; r=0,59, p<0,05), index of left atrium (r=0,48), isovolumetric relaxation time of left ventricle (IVRT; r=0,42), duration of diastole (r=0,52), enddiastolic dimension (EDD; r=0,42), left ventricular posterior wall thickness (LVPWth) in diastole (r=0,42), LVPWth in systole (r=0,48), interventricular septum thickness (IVST) in systole (r=0,71), stroke volume (SV; r=0,43), left ventricular mass (LVM; r=0,42), (p<0,05). At patients receiving PAPD, were received authentic interrelations between the duration of wave Р and the age (r=0,42), Kt/V (r =–0,43), BE (r=0,43), diameter of aorta root (r=0,61), size of LA (r=0,53), index LA (r=0,48), EDD (r=0,59), end-systolic dimension (ESD; r=0,45), end-diastolic volume (EDV; r=0,51), end-systolic volume (ESV; r=0,42), LVPWth in diastole (r=0,64), LVPWth in systole (r=0,53), SV (r=0,48), LVM (r=0,43), index of LVM (r=0,43), (p<0,05). In group of patients on HD were received authentic interrelations between the dispersion of wave Р with LVPWth in diastole (r=0,45), LVPWth in systole (r=0,48), IVST in a systole (r=0,71), ESV (r=0,44), minute volume (MV; r=0,42), (p<0,05). In group of patients receiving PAPD, correlation coefficient between dispersion of wave Р with Kt/V was r =-0,43, with IVRT r=0,46, (p<0,05). CONCLUSION. Increase of duration and dispersion of wave Р is promoted by age of patient, inadequate dialysis, dislocation of acid-alkali balance to basic direction and also increase of LA diameter, diastolic dysfunction and LV hypertrophy.

chronic kidney disease, atrium fibrillation, electrocardiography, duration of wave P, dispersion of wave P

1. Levey AS, Beto JA, Coronado BE et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular Disease. Am J Kidney Dis1998; 32 (5): 853-906

2. Мухин НА, Моисеев СВ, Фомин ВВ. Гипергомоцистеинемия – кардоиваскулярные проблемы нефрологических больных. Кардиоваскулярная терапия и профилактика 2002; 3: 85-94

3. Добронравов ВА, Смирнов АВ, Владимирова ЮФ, Боровская ЕА. Связь между развитием эпизодов ишемии миокарда и изменениями артериального давления у больных с ИБС, получающих лечение хроническим гемодиализом. Нефрология 2008; 12 (3): 24-35

4. Смирнов AB, Рыков ВГ, Суглобова ЕД, Васильев АН. Хронический гемодиализ и артериальная гипертензия. Нефрология 2004; 8 (2): 7-13

5. Chazan JA. Sudden death in patients with chronic renal failure on hemodialysis. Dial Transplant 1987; 16: 447–448

6. Михеева ЮС, Есаян АМ, Румянцев АШ. Нарушения ритма при лечении хроническим гемодиализом. Нефрология 2002; 6 (2): 58-62

7. USRDS. The United States Renal Data System. Am J Kidney Dis 2005; 45: 1-280

8. Chen LY, Shen WK. Epidemiology of atrial fibrillation: a current perspective. Heart Rhythm 2007; 4: 1-6

9. Kimura K, Tabei K, Asano Y, Hosodu S. Cardiac arrhythmias in hemodialysis patients. A study of incidence and contributary factors. Nephron 1989; 53: 201–207

10. Miyasaka Y, Barnes ME, Gersh BJ. et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 2006; 114: 119-125

11. Harnett JD, Foley RN, Kent GM et al. Congestive heart failure in dialysis patients: prevalence, incidence, prognosis and risk factors. Kidney Int 1995; 47: 884–890

12. Krane V, Heinrich F, Meesmann M et al. Electrocardiography and outcome in patients with diabetes mellitus on maintenance hemodialysis. Clin J Am Soc Nephrol 2009; 4(2): 394-400

13. Shimada K, Tomita T, Kamijo Y et al. Hemodialysis-induced P-wave signal-averaged electrocardiogram alterations are indicative of vulnerability to atrial arrhythmias. Circ J 2012; Jan 11 [Epub ahead of print]

14. Taskapan MC, Senel S, Ulutas O et al. Brain natriuretic peptide and P wave duration in dialysis patients. Int Urol Nephrol 2007; 39 (2): 603-608

15. Ozmen N, Cebeci BS, Kardesonglu E. Relationship between P-wave dispersion and effective hemodialysis in chronic hemodialysis patients. Med Princ Pract 2007; 16: 147-150

16. Szabу Z, Kakuk G, Fьlцp T. et al. Effects of haemodialysis on maximum P wave duration and P wave dispersion. Nephrol Dial Transplant 2002; 17; 9: 1634-1638

17. Tezcan UK, Amasyali B, Can I. Increased P wave dispersion and maximum P wave duration after hemodialysis. Ann Noninvasive Electrocardiol 2004; 9 (1): 34-38

18. Jaroszyсski AJ, Glowniak A, Sodolski T et al. Effect of haemodialysis on signal-averaged electrocardiogram P-wave parameters. Nephrol Dial Transplant 2006; 21 (2): 425-430

19. Ozben B, Toprak A, Koc M et al. P wave dispersion increases during hemodialysis sessions. Nephron Clin Pract 2009; 112(3): 171-176

20. Liu YY, Xie MX, Xu JF. Evaluation of left atrial function in patients with coronary artery disease by two-dimensional strain and strain rate imaging. Echocardiography 2011; 28 (10): 1095-1103

21. Liu JE, Devereux RB. Clinical assessment of cardiac hypertrophy. In: Sheridan D.J., ed. Left ventricular hypertrophy. 1t ed. Churchill Livingstone, London, UK, 1998: 11

22. Devereux RB, Alomso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy comparison to necropsy findings. Am J Cardiol 1986; 57: 450-458

23. Savage DD, Garrison RJ, Kannel WB et al. The spectrum of left ventricular hypertrophy in a general population sample: the Framingham study. Circulation 75 [Suppl I]. 1987; I: 26-33

24. Devereux RB, Lutas EM, Casale PN et al. Standarization of M-mode echocardiographic left ventricular anatomic measurements. Am J Cardiol 1984; 4: 1222-1230

25. Peters N, Schilling R, Kanagaratnam P et al. Atrial fibrillation: strategies to control, combat, and cure. Lancet 2002; 359: 593–603

26. Vázquez E, Sánchez-Perales C, Lozano C et al. Comparison of prognostic value of atrial fibrillation versus sinus rhythm in patients on long-term hemodialysis. Am J Cardiol 2003; 92: 868–871

27. Dagli N, Karaca I, Yavuzkir M et al. Are maximum P wave duration and P wave dispersion a marker of target organ damage in the hypertensive population? Clin Res Cardiology 2008; 97: 98-104

28. Шутов AM, Мастыков ВЭ, Едигарова ОМ. Диастолическая дисфункция и интрадиализная гипотензия. Нефрология и диализ 2003; 5 (2): 156-160

29. Zalman DF, Dilaveris PE, Gialafos JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation Ann Noninvasive Electrocardiol 2001; 6: 159-165

30. London GM. Heterogeneity of left ventricular hypertrophy – does it have clinical implications? Nephrol Dial Transplant 1998; 13: 17- 19