Estimation of potassium levels in hemodialysis patients by T wave nonlinear dynamics and morphology markers
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10.1016/j.compbiomed.2022.105304
Inclou dades d'ús des de 2022
Cita com:
hdl:2117/362707
Tipus de documentArticle
Data publicació2022-04
EditorElsevier
Condicions d'accésAccés obert
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Reconeixement-NoComercial-SenseObraDerivada 4.0 Internacional
Abstract
Objective: Noninvasive screening of hypo- and hyperkalemia can prevent fatal arrhythmia in end-stage renal disease (ESRD) patients, but current methods for monitoring of serum potassium ([K+]) have important limita-tions. We investigated changes in nonlinear dynamics and morphology of the T wave in the electrocardiogram (ECG) of ESRD patients during hemodialysis (HD), assessing their relationship with [K+]and designing a [K+]estimator. Methods: ECG recordings from twenty-nine ESRD patients undergoing HD were processed. T waves in 2-min windows were extracted at each hour during an HD session as well as at 48 h after HD start. T wave nonlinear dynamics were characterized by two indices related to the maximum Lyapunov exponent (¿t, ¿wt) and a divergence-related index (¿). Morphological variability in the T wave was evaluated by three time warping- based indices (dw, reflecting morphological variability in the time domain, and da and dNLa, in the amplitude domain). [K+]was measured from blood samples extracted during and after HD. Stage-specific and patient- specific [K+]estimators were built based on the quantified indices and leave-one-out cross-validation was per-formed separately for each of the estimators. Results: The analyzed indices showed high inter-individual variability in their relationship with [K+]. Never-theless, all of them had higher values at the HD start and 48 h after it, corresponding to the highest [K+]. The indices ¿ and dw were the most strongly correlated with [K+](median Pearson correlation coefficient of 0.78 and 0.83, respectively) and were used in univariable and multivariable linear [K+]estimators. Agreement between actual and estimated [K+]was confirmed, with averaged errors over patients and time points being 0.000 ±0.875 mM and 0.046 ±0.690 mM for stage-specific and patient-specific multivariable [K+]estimators, respectively. Conclusion: ECG descriptors of T wave nonlinear dynamics and morphological variability allow noninvasive monitoring of [K+]in ESRD patients. Significance: ECG markers have the potential to be used for hypo- and hyperkalemia screening in ESRD patients.
CitacióBukhari, H. [et al.]. Estimation of potassium levels in hemodialysis patients by T wave nonlinear dynamics and morphology markers. "Computers in biology and medicine", Abril 2022, vol. 143, p. 105304:1-105304:13.
ISSN0010-4825
Versió de l'editorhttps://www.sciencedirect.com/science/article/pii/S0010482522000968
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