Razi Journal of Medical Sciences

  Introduction : Hyperkalemia is a common disorder among renal failure patients and is considered as an important internal medicine emergency. On the other hand, considering the non-specific symptoms of hyperkalemia and its similarity to the underlying diseases’ symptoms, the occurrence of dangerous side effects is probable. One of the most important effects is on myocardium. Considering the immature mechanism of potassium conformity in confrontation with hyperkalemia in Acute Renal Failure (ARF) patients, the toxic effects of hyperkalemia occurs in lower potassium levels. The aim of this study is comparing the EKG changes due to hyperkalemia in patients with acute and chronic renal failure undergoing chronic hemodialysis.

  Methods : The recent study was an analytic cross-sectional one performed on patients hospitalized in hemodialysis ward in Hashemi Nejad, Shohadaye-hafte- tir and Rasoul Akram hospitals, during 1382-1383. The serum electrolyte levels and EKG changes of 138 patients with End Stage Renal Disease (ESRD) who were under chronic hemodialysis and 91 patients with ARF, who were hospitalized in different wards, were measured and evaluated, using SPSS V.11 software and t and Chi Square tests

  Results : Among 229 patients, 138 (60%) were ESRD patients who were under chronic hemodialysis and 91 (40%) had acute renal failure. The mean potassium level in ARF and ESRD patients were 5.66 ± 1.2 and 5.77 ± 0.91 mE/l which did not differ significantly (p=0.4). In EKG evaluations, the mean height of T wave, R wave and T/R ratio in ARF patients were 6.3 ± 2.4 mm, 5.7 ± 2.1 mm and 1.3 ± 0.9 mm respectively. These data in ESRD patients were 6 ± 2.2 mm, 5.6 ± 2.3 mm and 1.2 ± 0.78 mm. No significant difference was seen among two groups (P = 0.3, 0.8 and 0.7). In ARF and ESRD patients, there was a significant relationship between peaked tall T wave frequency and hyperkalemia severity (p<0.001). In the simultaneous presence of hyperkalemia and hypocalcemia, peaked tall T wave frequency, mean of R wave height and T/R ratio in ARF and ESRD groups were not significantly different. On the other hand, in the coincidence of hyperkalemia and hyponatremia peaked tall T wave frequency and T/R ratio in ARF and ESRD groups were significantly different. (P <0.05)

  Conclusion : Severe hyperkalemia, hyperkalemia in the setting of ARF and the simultaneous presence of hyperkalemia and hyponatremia may increase the probability of cardiac changes. These groups of patients who undergo hemodialysis need vigorous care considering the cardiac complications.