Hemodiyaliz hastalarında elektrokardiyografide fragmante qrs varlığının kardiak olay ve mortalite ile ilişkisi

OBJECTIVE: Fragmented QRS is seen in coronary artery disease and many cardiac diseases. However, there are very few publications dealing with the relation of fQRS with cardiac event and mortality in patients with chronic kidney disease and undergoing hemodialysis. In our study, we aimed to evaluate the relationship between the presence of fQRS in ECGs of patients undergoing hemodialysis, cardiac event and mortality. METHODS: 101 patients who underwent hemodialysis due to end-stage renal failure between 2008-2020 in Dokuz Eylul University Faculty of Medicine, Department of Internal Diseases, Department of Nephrology were included in the study. Demographic characteristics and laboratory parameters of the patients were recorded retrospectively. Standard 12-lead ECG records of the patients were obtained before and after the hemodialysis in 6-month follow-up. By recording the presence of fQRS in the ECG taken at any time; the relationship between the presence of fQRS with cardiac event occurrence and mortality within the evaluated time frame was evaluated. RESULTS: 38 of the patients were female and 63 were male. The mean age was 70.9 ± 12.6 years. While the most common cause of chronic kidney failure is diabetes mellitus with 36%; followed by hypertension 29% and chronic glomerulonephritis 9%, respectively. Smoking habit was detected in 44 patients (43.5%). The mean duration of hemodialysis was 74.0 ± 52.3 months. The Kt / V ratio was 1.4 ± 0.3 in all patients, and 1.2 ± 0.3 in the fQRS (+) patient group, and 1.4 ± 0.3 in the fQRS (-) patient group (p-value 0.064). Mean LDL level was 106.7 ± 34.3mg / dl. On ECHO performed on the patients included in the study, the LVEF was found to be 53.1 ± 13% in the group with fQRS (+) and 60.1 ± 6% in the group with fQRS (-) (p-value: 0.024). FQRS was detected in 39 of all patients. While fQRS was detected in the first ECG in 27 patients evaluated; In 12 patients, fQRS was absent at the beginning of dialysis treatment, and fQRS occurred during follow-up. Coronary artery disease was detected in 36% of the patients. Acute myocardial infarction was detected in 10 (12.5%) of the patients included in the study within the time period evaluated. In 6 (60%) of these 10 patients, fQRS was detected in ECG. Mortality was detected in 32 patients within the time period evaluated. In 11 (34.4%) patients with mortality, fQRS was observed in ECG. In logistic regression analysis, the relationship between cardiac event and smoking and presence of fQRS in ECG was evaluated. It was found that smoking increased the frequency of cardiac events 3.99 times in this patient group. In our patient group, it was observed that the presence of fQRS increased the risk of developing cardiac events 5.84 times. In terms of mortality, it was observed that every 1 g / dl increase in hemoglobin level provided a 30% reduction in mortality risk. In our patient group, it was found that the mortality risk increased by 5% as the age increased every 1 year. Again, as LVEF increased, a 5% decrease in mortality was observed. There was no statistically significant relationship between the presence of fragmented QRS and mortality. CONCLUSION: In this study, we showed the presence of fQRS in chronic kidney disease by using 12-lead ECG, an easily accessible and economical test. We think that this parameter, which can easily be evaluated in clinical practice. The effect of the presence of fQRS on mortality and morbidity should be examined further in studies with more patients and clinical follow-up. KEY WORDS: Fragmented QRS, chronic kidney disease