PREVALÊNCIA DAS ALTERAÇÕES ELETROCARDIOGRÁFICAS EM PACIENTES HEMODIALÍTICOS NO EXTREMO SUL CATARINENSE
Palavras-chave:
Sindrome cardiorrenal, Eletrocardiograma, Doença Renal Crônica, Diálise RenalResumo
Introdução: A progressão da doença renal cronica causa instabilidade metabólica, potencialmente letal. Atualmente, o transplante renal é considerado o melhor tratamento, proporcionando qualidade de vida ao indivíduo. Infelizmente, nem todos os nefropatas são elegíveis, necessitando de diálise renal para sobreviver. Estes pacientes têm elevada mortalidade, pois tanto a disfunção renal quanto a terapia corretiva infringem danos cardíacos, resultando na síndrome cardiorrenal. Nesse contexto, é imperativo que existam formas eficazes para o rastreio e diagnóstico de doenças cardíacas neste grupo, sendo o eletrocardiograma uma das opções para triagem, já que sua realização é segura, rápida e barata. Assim, este estudo propõe o uso do eletrocardiograma para avaliar a prevalência de alterações cardiovasculares em pacientes hemodialíticos do extremo sul catarinense. Métodos: Estudo transversal, aprovado pelo comitê de ética da universidade federal de Santa Catarina (CAAE:73389023.1.0000.0121) realizado em outubro/2023 via realização de eletrocardiogramas em 41 pacientes hemodialiticos adultos, não portadores de marcapasso do Hospital Regional Deputado Afonso Guizzo, analisados por cardiologista experiente. Resultados: As prevalências encontradas foram 4,8% dos pacientes apresentaram fibrilação atrial, 14,6% bloqueio atrioventricular de I grau, 9,75% extrassístoles supraventriculares, 12,1% extrassistoles ventriculares, 63,4% sobrecarga atrial esquerda, 75% hipertrofia ventricular esquerda, 53,5% alterações na repolarização, 24,3% Intervalo QT corrigido longo, 14,6% fragmentação do QRS. Conclusão: O estudo demonstra alta prevalência de alterações eletrocardiográficas no grupo, sinalizando risco cardíaco aumentado, ou presença de doença cardíaca estrutural. Estudos maiores são necessários para determinar os parâmetros nacionais.
Referências
Vareesangthip K, Yincharoen P, Winijkul A, et al. Cardiac arrhythmia during early‐week and mid‐week dialysis in hemodialysis patients. Therapeutic Apheresis and Dialysis. 2021 Mar 16;
Tumlin JA, Roy-Chaudhury P, Koplan BA, et al. Relationship between dialytic parameters and reviewer confirmed arrhythmias in hemodialysis patients in the monitoring in dialysis study. BMC Nephrology [Internet]. 2019 Mar 5 [cited 2022 Nov 17];20(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402171/pdf/12882_2019_Article_1212.pdf
Zanib A, Anwar S, Saleem K, et al. Frequency of Left Ventricular Hypertrophy Among Patients on Maintenance Hemodialysis by Voltage Criteria and Its Relationship with Biophysical-Chemical Parameters. Cureus. 2020 Mar 26;
Coll M, Carles Ferrer-Costa, Pich S, et al. Role of genetic and electrolyte abnormalities in prolonged QTc interval and sudden cardiac death in end-stage renal disease patients. PloS one. 2018 Jul 18;13(7):e0200756–6.
Nerbass FB, Lima H do N, Thomé FS, et al. Censo Brasileiro de Diálise 2021. Brazilian Journal of Nephrology. 2022 Nov 4;
Yehia H, Youssef G, Gamil M, et al. Electrocardiographic substrates of arrhythmias in patients with end-stage and chronic kidney diseases: a case–control study. The Egyptian Heart Journal /The Egyptian Heart Journal. 2023 Feb 21;75(1).
Hela Jebali, Hiba Ghabi, Mami I, et al. Evaluation of electrocardiographic findings before and after hemodialysis session. Saudi journal of kidney diseases and transplantation/Našrat amraḍ wa zira’aẗ al-kulaẗ. 2020 Jan 1;31(3):639–9.
Yamaguchi S, Hamano T, Oka, et al. Electrocardiogram findings at the initiation of hemodialysis and types of subsequent cardiovascular events. Hypertension research. 2021 Jan 4;44(5):571–80.
Skampardoni S, Poulikakos D, Malik, et al. The potential of electrocardiography for cardiac risk prediction in chronic and end-stage kidney disease. Nephrology Dialysis Transplantation. 2018 Aug 6;34(7):1089–98.
Samesima N, God EG, Kruse JCL, et al. Diretriz da Sociedade Brasileira de Cardiologia sobre a Análise e Emissão de Laudos Eletrocardiográficos – 2022. Arquivos Brasileiros de Cardiologia [Internet]. 2022 Sep 9; Available from: https://abccardiol.org/wp-content/uploads/articles_xml/0066-782X-abc-119-04-0638/0066-782X-abc-119-04-0638.x55156.pdf
Thurlow JS, Joshi M, Yan G, et al. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. American Journal of Nephrology. 2021;52(2):98–107.
Censo Brasileiro de Diálise de 2023 [Internet]. www.censo-sbn.org.br. [cited 2024 Jun 6]. Available from: http://www.censo-sbn.org.br/censosAnteriores
Tandukar S, Palevsky PM. Continuous Renal Replacement Therapy. Chest. 2019 Mar;155(3):626–38.
Liu P, Wang L, Han D, et al. Acquired long QT syndrome in chronic kidney disease patients. Renal Failure. 2019 Dec 27;42(1):54–65.
London GM, Marchais SJ, Guerin AP, et al. Arteriosclerosis, vascular calcifications and cardiovascular disease in uremia. Current Opinion in Nephrology and Hypertension. 2005 Nov 1;14(6):525–31.
Braunisch MC, Gundel P, Werfel S, et al. Electrocardiographic parameters of left ventricular hypertrophy and prediction of mortality in hemodialysis patients. Journal of Nephrology. 2021 May 20;35(1):233–44.
Soumaya Chargui, Emna Allouche, Wiem Dkhil, et al. Hypertrophie ventriculaire gauche chez les hémodialysés : prévalence, étude électrique, échographique et facteurs de risque. Néphrologie & Thérapeutique. 2022 Jul 1;18(4):247–54.
McIntyre CW, Burton JO, Selby NM, et al. Hemodialysis-Induced Cardiac Dysfunction Is Associated with an Acute Reduction in Global and Segmental Myocardial Blood Flow. Clinical Journal of the American Society of Nephrology. 2007 Nov 14;3(1):19–26.
Rantanen JM, Riahi S, Schmidt EB, et al. Arrhythmias in Patients on Maintenance Dialysis: A Cross-sectional Study. American Journal of Kidney Diseases. 2020 Feb;75(2):214–24.
Foley RN, Parfrey PS, Harnett JD, et al. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney International [Internet]. 1995 Jan 1;47(1):186–92. Available from: https://www.sciencedirect.com/science/article/pii/S0085253815587784
Go AS, Hylek EM, Phillips KA, et al. Prevalence of Diagnosed Atrial Fibrillation in Adults. JAMA [Internet]. 2001 May 9;285(18):2370. Available from: https://jamanetwork.com/journals/jama/fullarticle/193807
Justo FA, Silva AFG. Aspectos epidemiológicos da fibrilação atrial. Revista de Medicina. 2014 Oct 23;93(1):1.
Moreira DAR, Felicioni SP, Brito FS de. As arritmias avaliadas pela eletrocardiografia dinâmica e pelo teste ergométrico: entendendo seu significado e como conduzir. Rev Soc Cardiol Estado de Säo Paulo [Internet]. 2009;412–26. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/lil-538340
Muhieddine Omar Chokr. Extrassístoles Ventriculares Frequentes: Quando Tratar E Quando Indicar Ablação. Revista da Sociedade de Cardiologia do Estado de São Paulo. 2023 Jun 30;33(2):169–77.
Klewer J, Springer J, Morshedzadeh J. Premature Ventricular Contractions (PVCs): A Narrative Review. The American Journal of Medicine [Internet]. 2022 Jul 27;135(11):S0002-9343(22)005277. Available from: https://pubmed.ncbi.nlm.nih.gov/35907515/
Marcus GM. Evaluation and Management of Premature Ventricular Complexes. Circulation. 2020 Apr 28;141(17):1404–18.
Tan Chen Wu. Bloqueio Atrioventricular de 1o Grau: Um Achado nem Sempre Benigno!. 2022 Jan 1;119(4):572–3.
Paixão GM de M, Lima EM, Quadros AB, et al. Associação entre Bloqueio Atrioventricular e Mortalidade em Pacientes de Atenção Primária: O Estudo CODE. Arquivos Brasileiros de Cardiologia. 2022 Jul 13;
Haukilahti MAE, Holmström L, Vähätalo J, et al. Gender differences in prevalence and prognostic value of fragmented QRS complex. Journal of Electrocardiology. 2020 Jul;61:1–9.
Liu P, Wu J, Wang L, et al.. The prevalence of fragmented QRS and its relationship with left ventricular systolic function in chronic kidney disease. Journal of International Medical Research. 2019 Dec 24;48(4):030006051989079.
Ramu B, Elwan AM, Coleman CI, et al. The Association Between Baseline Left Atrial Volume Index and All-Cause Mortality in Patients with Heart Failure: A Meta-Analysis. Connecticut Medicine [Internet]. 2015 Sep 1;79(8):469–75. Available from: https://pubmed.ncbi.nlm.nih.gov/26506678/
Hellman T, Hakamäki M, Roosa Lankinen, et al. Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease. BMC cardiovascular disorders. 2020 Oct 7;20(1).
Tikkanen JT, Kenttä T, Porthan K, et al. Electrocardiographic T Wave Abnormalities and the Risk of Sudden Cardiac Death: The Finnish Perspective. Annals of Noninvasive Electrocardiology. 2015 Sep 22;20(6):526–33.
Schillaci G, Pirro M, Pasqualini L et al. Prognostic significance of isolated, non-specific left ventricular repolarization abnormalities in hypertension. Journal of hypertension. 2004 Feb 1;22(2):407–14.
Laukkanen JA, Di Angelantonio E, Khan et al. T-wave inversion, QRS duration, and QRS/T angle as electrocardiographic predictors of the risk for sudden cardiac death. The American Journal of Cardiology [Internet]. 2014 Apr 1;113(7):1178–83. Available from: https://pubmed.ncbi.nlm.nih.gov/24513474/
Di Iorio B, Bellasi A. QT interval in CKD and haemodialysis patients. Clinical Kidney Journal [Internet]. 2013 Jan 17;6(2):137–43. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432438/
Sun Moon Kim, George B, Alcivar-Franco D, et al. QT prolongation is associated with increased mortality in end stage liver disease. World Journal of Cardiology. 2017 Jan 1;9(4):347–7.
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2025 Arquivos Catarinenses de Medicina
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
