Can hemodialysis change QRS axis in patients without cardiovascular disease?

OBJECTIVE
Due to rapid changes in volume and electrolyte concentration during hemodialysis (HD), some electrocardiographic (ECG) changes or arrhythmias can be seen. The aim of this study was to assess ECG QRS axis changes and other ECG parameters after HD in patients with end-stage renal disease (ESRD).

METHODS
A total of 46 patients (65% male, mean age 52±15 years) with a sinus rhythm and without cardiovascular disease who were undergoing chronic HD treatment were included to the study. Blood samples, 12-lead electrocardiograms, and echocardiograms were recorded immediately before and at the end of an HD session. The QRS axis and other electrocardiographic, echocardiographic, electrolyte parameter, and volume changes were analyzed.

RESULTS
The serum urea, creatinine, potassium, and B-type natriuretic peptide concentrations significantly decreased after HD, and the serum calcium levels significantly increased after HD. Body weight significantly decreased after HD. There was no significant difference in the QRS duration, PR interval, P-wave axis, QRS axis, or QT and QTc interval following HD. Based on a comparison of variables according to the any QRS axis change after HD treatment, there was no significant difference in biochemical values, HD time, ultrafiltration volume, left ventricular ejection fraction, or other echocardiographic findings.

CONCLUSION
ESRD and HD are complex and dynamic processes, and the change in the QRS axis is rarely emphasized in these patients. In our study, there was no significant change in the QRS axis with HD in patients without cardiovascular disease.