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| Year : 2008 | Volume
: 19
| Issue : 4 | Page : 648-650 |
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| Electrocardiographic R wave increases after Hemodialysis: Round III |
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Charles J Diskin
Hypertension, Nephrology, Dialysis and Transplantation, Auburn University, Suite 3, 2609 Village Professional drive Opelika AL 36801
Click here for correspondence address and email
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How to cite this article:
Diskin CJ. Electrocardiographic R wave increases after Hemodialysis: Round III. Saudi J Kidney Dis Transpl 2008;19:648-50 |
To the Editor,
I would like to congratulate Dr. Tarif and his colleagues for their work on electrocardiographic changes after hemodialysis that found a decrease in the T/R amplitude. [1] While their data is a valuable addition to this area, because it has been almost thirty years since we first described the increase in R wave amplitude in the EKG after hemodialysis, [2] I thought that I might be able to add some further insight into their findings. While I am quite sure that Dr. Tarif is correct in his conclusion that the decrease in T/R was due more to a reduction in the T wave amplitude which almost certainly was due to a reduction in the potassium levels, I am not as certain that the increase in R wave amplitude was related to potassium. More recently investigators have suggested that the R wave increase is due to volume removal. [3] Unfortunately, a review of our original data would tend to lend doubt to that speculation. [4] [Figure 1],[Table 1]. While our data would tend to lend more support to Dr. Tarif's speculation that the effect occurs more as a result of potassium perturbations than Dr. Madias' theory of volume, the data is not totally conclusive. We found that the only significant correlation of R wave increase for our data was the potassium bath [Table 1]; yet, we could not correlate those changes with individual changes in each patient's serum potassium levels. Furthermore, since further study revealed an association with thallium defects, [5] the increase in R wave values may be a subtle manifestation of ischemia. While the data of Dr. Tarif is interesting, I would urge caution in attributing the sole cause as a reduction in potassium values at present and I look forward to their further work in this area.
 References | |  |
| 1. | Tarif N, Yamani H, Bakhsh AJ, et al. Electrocardiography and serum potassium before and after hemodialysis sessions. Saudi J Kidney Dis Transpl 2008;19(1):47-53.  |
| 2. | Diskin CJ, Salzsieder KH, Solomon RJ, Carvalho JS, Trebbin WM. Electrocardiographic changes following dialysis. Nephron 1981;27(2):94-100. |
| 3. | Madias JE. Increases in P-wave duration and dispersion after hemodialysis are totally (or partially) due to the procedure-induced alleviation of the body fluid overload: a hypothesis with strong experimental support. Ann Noninvasive Electrocardiol 2005;10 (2):129-33. |
| 4. | Diskin CJ. R wave increases after hemodialysis revisited. Ann Noninvasive Electrocardiol 2006;11(2):198-9. |
| 5. | Gelber CM, Diskin CJ, Claunch BC, et al. Thallium-201 myocardial imaging in patients on chronic hemodialysis. Nephron 1984;36 (2):136-42 |
Correspondence Address:
Charles J Diskin
Hypertension, Nephrology, Dialysis and Transplantation, Auburn University, Suite 3, 2609 Village Professional drive Opelika AL 36801
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 18580031 
[Figure 1]
[Table 1] |
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