when is the best time to do ECG for dialysis patient

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Hi ,dear fellows ,

I am working in a dialysis center , our company clinical setting require to do yearly ECG and 2yearly X-RAY for all the dialysis I patient , most time we do ECG for patient is pre dialysis, and I was told not allow to do ECG for patient after dialysis , could anyone here has better idea about it ?

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Specializes in critical care ICU.

Dialysis involves a lot of rapid fluid shifts in the body. Chemistry is changed over hours instead of over days as a working kidney would take. ECG can pick up benign arrhythmias caused by electrolyte shifts. The body does adjust, but right after HD is not a good time to interpret an ECG. It's not their baseline.

*please correct me if there are any mistakes in my explanation. Brand new grad. I work in tele and have patients routinely in HD, so this was as best as I could explain

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THe key point is when is the hemodynamics stable time ,pre dialysis or post dialysis , usually post dx already removed the extra fluid and k, pre dx patient loaded with extra and k

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Specializes in Dialysis Acute & Chronic.

Similar to why if you forget labs you can't draw mid treatment. Prior to the blood hitting the dializer, the patients blood is untreated and a better indication of what a patients labs are like. 2 ECG's on the same patient will look different; QRS complex will be pointy becuase of a higher K+ pre than post treatment. Thats a small example.

Post treatment patients K's Ca's and Na's will be what ever the dialysate level of those lytes are. 2.0 K bath 2.5 Ca+ bath for example. The body will diffuse into the blood stream slowly between treatments and increase those levels. So a pre ECG will show a patients true rhythm because the lytes wont be altered by the treatment.

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I would think it doesn't matter. The point isn't to demonstrate pre or post dialysis EKG changes. People with end stage renal disease are at very high risk for cardiovascular comorbidities and the EKG is just a part of following that progression over a years time. It shouldn't look very much different at all before or after routine, scheduled hemodialysis in most cases.

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Specializes in Dialysis Acute & Chronic.
It shouldn't look very much different at all before or after routine, scheduled hemodialysis in most cases.

ECG measures electrical activity... a high K will have implications to the ECG.. widened QRS.. more K competing for bonding sites. So TBH it does make a difference because every patient post dialysis will have a similar ECG because the blood electrolytes will match that of the dialysate until the body can diffuse more electrolytes from the interstitial space to the vascular space.

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ECG measures electrical activity... a high K will have implications to the ECG.. widened QRS.. more K competing for bonding sites. So TBH it does make a difference because every patient post dialysis will have a similar ECG because the blood electrolytes will match that of the dialysate until the body can diffuse more electrolytes from the interstitial space to the vascular space.

You're not looking for electrolyte mediated changes in the T and R waves. You're looking for evidence of myocardial damage as a comorbidity of CKD.

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Specializes in Dialysis Acute & Chronic.
You're not looking for electrolyte mediated changes in the T and R waves. You're looking for evidence of myocardial damage as a comorbidity of CKD.

Exactly my point--you would want to check the ECG before dialysis. Following treatment, a patients K, Ca, and Na will be that of the Acid used for tx. This could hide a patients underlying rhythm. So to answer this posters question, check before not after.

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Exactly my point--you would want to check the ECG before dialysis. Following treatment, a patients K, Ca, and Na will be that of the Acid used for tx. This could hide a patients underlying rhythm. So to answer this posters question, check before not after.

So, after dialysis the patients commonly measured electrolytes will be normal, in other words. And before dialysis they won't be. So get the EKG before dialysis? To not avoid electrolyte disturbance artifact on the EKG?

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Specializes in Critical Care.

The signs of ischemia that we would be using a 12 lead to look for don't vary based on electrolyte levels. They can be obscured by electrolyte levels that are severely out of range, for instance if severe hyperkalemia (greater than 7 or 8) was causing an idioventricular rhythm then the 12 lead could not be read properly, although if that's the case then you've got bigger problems than a hard to read 12 lead. If the ability ischemic changes on an EKG had to be corrected for electrolyte levels then no 12 lead would be useful without taking simultaneous electrolyte levels and adjusting for them, which isnt' how it works.

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Specializes in Dialysis.

Severe hypokalemia masquerading myocardial ischemia.

Severe Hypokalemia Masquerading Myocardial Ischemia | Petrov | Cardiology Research

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1. Which is why EKG's are only one piece of the exam.

2. The probably knew it wasn't an MI before they got the troponin back because the K comes back sooner.

dialysis patient complaining of CP and hypotension is different than a 33 yo male who has been barfing with diarrhea for two days.

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