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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 4  |  Page : 648-650
Electrocardiographic R wave increases after Hemodialysis: Round III


Hypertension, Nephrology, Dialysis and Transplantation, Auburn University, Suite 3, 2609 Village Professional drive Opelika AL 36801

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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

How to cite this URL:
Diskin CJ. Electrocardiographic R wave increases after Hemodialysis: Round III. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2020 Sep 25];19:648-50. Available from: http://www.sjkdt.org/text.asp?2008/19/4/648/41332
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 Top

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.  Back to cited text no. 1    
2.Diskin CJ, Salzsieder KH, Solomon RJ, Carvalho JS, Trebbin WM. Electrocardio­graphic changes following dialysis. Nephron 1981;27(2):94-100.  Back to cited text no. 2    
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.  Back to cited text no. 3    
4.Diskin CJ. R wave increases after hemo­dialysis revisited. Ann Noninvasive Electro­cardiol 2006;11(2):198-9.  Back to cited text no. 4    
5.Gelber CM, Diskin CJ, Claunch BC, et al. Thallium-201 myocardial imaging in patients on chronic hemodialysis. Nephron 1984;36 (2):136-42  Back to cited text no. 5    

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Correspondence Address:
Charles J Diskin
Hypertension, Nephrology, Dialysis and Transplantation, Auburn University, Suite 3, 2609 Village Professional drive Opelika AL 36801

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PMID: 18580031

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