Prevalence of electrocardiographic abnormalities in patients with chronic kidney disease

The presence of electrocardiogram (ECG) abnormalities is high in patients with end-stage kidney disease, but no studies have examined the prevalence of ECG abnormalities according to different strata of estimated glomerular filtration rate (eGFR) in a population-based setting.This was a retrospective cross-sectional study including 310,060 individuals from the Copenhagen General Practitioners' Laboratory who had an available digital ECG recorded between 2001 and 2015 and a creatinine measurement within 7 days of the ECG. eGFR was calculated using the The Chronic Kidney Disease Epidemiology Collaboration equation. ECG abnormalities were categorized as no, minor or major, as done previously [1]. Patients with both minor and major ECG abnormalities were assigned as major ECG abnormalities. The prevalence of ECG abnormalities was examined according to different strata of renal function [eGFR (ml/min/1.73 m2) \gt;90, 61–90, 46–60, 31–45, 30-16 and ≤15]. Ordinal logistic regression was used to illustrate the probability of ECG abnormalities as a function of eGFR.The median age was 55 [IQR, 41-69] years and 46\7,249 (17.9\ of the included patients had an eGFR \lt;60. The prevalence of major ECG abnormalities increased with declining eGFR: \gt;90 (16.5\, 61–90 (21.6\, 46–60 (36.5\ 31–45 (52.1\, 30-16 (57.9\ and ≤15 (60.1\. In ordinal logistic regression, the risk of having major ECG abnormalities compared to minor/no abnormalities significantly decreased pr. 5 ml/min increase in eGFR, OR 0.90 (95\ 0.85-0.90), Fig. 1. The most common major ECG abnormalities were left ventricular hypertrophy and ST-T deviations. The prevalence of all ECG abnormalities is shown in Table 1.Figure 1:Predicted probability of ECG abnormalities according to eGFR.Table 1:Prevalence of ECG abnormalities.eGFR (ml/min/1.73 m2)\gt;90n = 105,10561-90n = 153,98446-60n = 36,20931-45n = 11,60616-30n = 2732≤15n = 424Age, yrs (median, iqr)42 (30-53)57 (46-68)75 (66-82)83 (76-88)84 (78-89)82 (70-89)Males53,221 (50.6)73,157 (47.5)11,630 (32.1)3504 (30.2)962 (35.2)197 (46.5)Heart rate, bpm (median, iqr)69 (61-78)69 (61-78)72 (63-82)73 (64-84)73 (64-85)76 (66-86)No ECG abnormality82,968 (78.9)111,962 (72.7)20,717 (57.2)4714 (40.6)901 (33.0)132 (31.1)Minor ECG abnormality4782 (4.5)8744 (5.7)2280 (6.3)846 (7.3)248 (9.1)37 (8.7) First-degree atrioventricular block1736 (1.7)5748 (3.7)2628 (7.3)1306 (11.3)385 (14.1)63 (14.9) Incomplete bundle branch block2420 (2.3)3734 (2.4)790 (2.2)260 (2.2)75 (2.7)9 (2.1) Left fascicular block1212 (1.2)1836 (1.2)649 (1.8)260 (2.2)63 (2.3)18 (4.2) QTcF prolongation1854 (1.8)5554 (3.6)2212 (6.1)1141 (9.8)385 (14.1)79 (18.6)Major ECG abnormality17,355 (16.5)33,278 (21.6)13,212 (36.5)6046 (52.1)1583 (57.9)255 (60.1) Left ventricular hyperthrophy9822 (9.3)14,438 (9.4)4930 (13.6)2061 (17.8)535 (19.6)100 (23.6) Atrial fibrillation663 (0.6)4257 (2.8)2907 (8.0)1628 (14.0)428 (15.7)54 (12.7) Bundle branch block1160 (1.1)4663 (3.0)2412 (6.7)1324 (11.4)380 (13.9)54 (12.7) Intraventricular conduction disorder725 (0.7)1149 (0.7)322 (0.9)171 (1.5)48 (1.8)10 (2.4) Q waves3560 (3.4)8115 (5.3)2911 (8.0)1186 (10.2)293 (10.7)40 (9.4) ST-T deviations2802 (2.7)5729 (3.7)3247 (9.0)1853 (16.0)552 (20.2)86 (20.3)ECG abnormalities are common in patients with chronic kidney disease, and the probability of major ECG abnormalities increases with declining eGFR.