Proporsi Pemanjangan Dispersi QT Predialisis pada Pasien Hemodialisis Kronik Dua Kali Seminggu dan Faktor-Faktor yang Berhubungan

Arief Pattiiha, Muhammad Yamin, Aida Lydia, Murdani Abdullah

Abstract

Pendahuluan. Penyakit kardiovaskular merupakan penyebab utama mortalitas pada pasien penyakit ginjal tahap akhir (PGTA) yang menjalani hemodialisis (HD). Penyebab penyakit kardiovaskular pada PGTA bersifat multifaktorial. Aritmia ventrikel telah terbukti sebagai penyebab utama kematian mendadak pasien HD. Salah satu parameter untuk menilai risiko aritmia pada pasien HD adalah dengan melihat dispersi QT dari pemeriksaan elektrokardiografi (EKG). Studi ini dilakukan untuk mengetahui proporsi pemanjangan dispersi QT predialisis pada pasien HD kronik dua kali seminggu dan faktor-faktor yang berhubungan.
Metode. Studi potong lintang dilakukan pada pasien HD berusia ≥18 tahun dan durasi HD ≥3 bulan di RSUPN Dr. Cipto Mangunkusumo periode Mei – Juni 2019. Pemeriksaan EKG, ekokardiografi, dan pengambilan sampel darah dilakukan sebelum sesi HD. Analisis bivariat dilakukan dengan uji Chi-square dan Fisher’s exact, dilanjutkan analisis multivariat dengan regresi logistik terhadap variabel bermakna.
Hasil. Dari total 142 subjek, didapatkan usia rerata subjek 49 (simpang baku [SB] 15) tahun. Pemanjangan dispersi QT didapatkan pada 51 subjek (35,9%). Hasil analisis multivariat menunjukkan pemanjangan dispersi QT berhubungan signifikan dengan disfungsi sistolik (PR=1,875 (IK95% 1,234-2,848); p=0,006) dan hipertrofi ventrikel kiri (PR=2,361 (IK95% 1,032-5,40)3; p=0,0191). Adapun usia, diabetes melitus, hipokalemia, hipomagnesemia, dan disfungsi diastolik tidak berhubungan secara signifikan dengan pemanjangan dispersi QT (p>0,05).
Simpulan. Proporsi pemanjangan dispersi QT predialisis pasien HD kronik dua kali seminggu di RSUPN Dr. Cipto Mangunkusumo yaitu 35,9% dan berhubungan dengan disfungsi sistolik dan hipertrofi ventrikel kiri.
Kata Kunci: Dispersi QT, elektrokardiografi, ekokardiografi, hemodialisis

 

Proportion of Pre-dialysis Prolonged QT Dispersion in Twice-Weekly Chronic Hemodialysis Patients and Its Associated Factors

Introduction. Cardiovascular disease (CVD) is the common cause of mortality in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Causes of CVD in ESRD patients are multifactorial. Ventricular arrhythmia is known as the leading cause of sudden death in dialysis patients. QT dispersion, which is measured from electrocardiography (ECG), is known as one of the parameters to assess the risk of arrhythmia in HD patients. This study aimed to determine the proportion of pre-dialysis prolonged QT dispersion in chronic twice-weekly HD patients and the associated factors.
Methods. A cross-sectional study was conducted among HD patients age ≥18 years with dialysis duration of at least three months in Cipto Mangunkusumo Hospital during May–June 2019. Electrocardiography, echocardiography, and blood samples were taken before the dialysis session. Bivariate analysis using Chi-square and Fisher’s exact test was performed on each variable. Significant results were further analysed using logistic regression.
Results. A total of 142 subjects were included in this study. The mean age of subjects was 49 (standard deviation (SD) 15) years. Prolonged QT dispersion was found in 51 subjects (35.9%). Multivariate analysis showed prolonged QT dispersion was significantly correlated with systolic dysfunction (PR=1.875 (CI 95% 1.234-2.848); p=0.006) and left ventricle hypertrophy (PR=2.361 (CI 95% 1.032-5.403); p=0.019). Age, diabetes mellitus, hypokalemia, hypomagnesemia, and diastolic dysfunction were not significantly correlated with QT dispersion (p>0.05).
Conclusion. The proportion of pre-dialysis prolonged QT dispersion in twice-weekly chronic hemodialysis patients in RSCM is 35.9% and associated with systolic dysfunction and left ventricle hypertrophy.

Keywords

QT Dispersion, Electrocardiography, Echocardiography, Hemodialysis

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