Initial and terminal T wave angle as hyperkalemia indicator in chronic kidney disease

ABSTRACT

Background

Hyperkalemia is one prevalent complication in chronic kidney disease and is considered fatal since it potentially causes malignant arrhythmias and mortality. It is associated with electrocardiography (ECG) changes, such as peaked T wave in all ECG leads. However, the universal definition of the peaked T wave is still unclear, with low sensitivity and specificity.

Aim

This study aims to determine the predictive value of initial and terminal T wave angle in detecting hyperkalemia among CKD patients.

Methods

A cross-sectional study was conducted at Dr. Soetomo General Hospital, including all adult hospitalized CKD patients. A caliper was used to measure T wave morphology. The initial deflection angle (Tia) and terminal deflection angle (Tta) were calculated from an arctan of T peak amplitude and the respective initial or terminal length. The receiver operating characteristics (ROC) curve was analyzed to determine the area under the curve (AUC) and optimal cutoff.

Results

A total of 220 CKD patients were enrolled in this study, with 98 patients with hyperkalemia (potassium >5.0). The majority of the patients were male, with a mean age of 51.12 ± 12.58 years. Ti-Tp duration, Tp-Tt duration, Tia, Tta, and Tp amplitude were significantly higher in the hyperkalemia group (all p < 0.05). A Spearman correlation analysis demonstrated a significant positive correlation of Tia (r = 0.346 and p < 0.001) and Tta (r = 0.445 and p < 0.001) with potassium levels in the participants. The optimal cutoff angle for Tta was 66.20° (sensitivity = 67.3% and specificity = 73.8%) and Tia was 61.07° (sensitivity = 66.3% and specificity = 69.7%).

Conclusion

The terminal T wave angle outperformed the initial angle in predicting hyperkalemia in CKD patients.

KEYWORDS:

• Electrocardiography
• potassium
• hyperkalemia
• chronic kidney disease
• peaked T wave

Disclosure of any financial/other conflicts of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Study Design: EPBM, FMY, RJ. Data Collection: EPBM, KL, RJ. Statistical Analysis: EPBM, KL, FMY. Data Interpretation: EPBM, FMY, RJ. Manuscript Preparation: EPBM, KL, FMY. Literature Search: EPBM, KL. Funds Collection: RJ.

Data availability statement

The datasets generated during and/or analyzed during the current study are not publicly available due to protecting participant confidentiality but are available from the corresponding author on reasonable request.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2022.2109336

Ethical clearance

This study followed the principles of the Declaration of Helsinki and was approved by Dr. Soetomo General Hospital ethical committees (Ethical clearance number: 1811/ KEPK/II/2020).

Ethical approval and consent to participate

This research proposal was approved by Dr. Soetomo General Academic Hospital’s ethical committee (Ref: 1811/ KEPK/ II/ 2020). Written informed consent was obtained from all patients.

Human and animal rights

No animals were used in this research. All human research procedures were followed following the ethical standards of the committee responsible for human experimentation (institutional) and with the Helsinki Declaration of 1975, as revised in 2013.

Social media

Eka Prasetya Budi Mulia (twitter: @eka_praste; Linkedin: Eka Prasetya Budi Mulia)

Filipus Michael Yofrido (twitter: @filipus_michael; Linkedin: Filipus Michael Yofrido)

Additional information

Funding

No funding was received for the production of this manuscript.