Monitoring of serum potassium and calcium levels in end-stage renal disease patients by ecg depolarization morphology analysis

Bukhari, Syed Hassaan Ahmed (Universidad de Zaragoza) ; Sánchez, Carlos (Universidad de Zaragoza) ; Ruiz, José Esteban (Universidad de Zaragoza) ; Potse, Mark ; Laguna, Pablo (Universidad de Zaragoza) ; Pueyo, Esther (Universidad de Zaragoza)

Resumen: Objective: Non-invasive estimation of serum potassium, [K+], and calcium, [Ca2+], can help to prevent life-threatening ventricular arrhythmias in patients with advanced renal disease, but current methods for estimation of electrolyte levels have limitations. We aimed to develop new markers based on the morphology of the QRS complex of the electrocardiogram (ECG). Methods: ECG recordings from 29 patients undergoing hemodialysis (HD) were processed. Mean warped QRS complexes were computed in two-minute windows at the start of an HD session, at the end of each HD hour and 48 h after it. We quantified QRS width, amplitude and the proposed QRS morphology-based markers that were computed by warping techniques. Reference [K+] and [Ca2+] were determined from blood samples acquired at the time points where the markers were estimated. Linear regression models were used to estimate electrolyte levels from the QRS markers individually and in combination with T wave morphology markers. Leave-one-out cross-validation was used to assess the performance of the estimators. Results: All markers, except for QRS width, strongly correlated with [K+] (median Pearson correlation coefficients, r, ranging from 0.81 to 0.87) and with [Ca2+] (r ranging from 0.61 to 0.76). QRS morphology markers showed very low sensitivity to heart rate (HR). Actual and estimated serum electrolyte levels differed, on average, by less than 0.035 mM (relative error of 0.018) for [K+] and 0.010 mM (relative error of 0.004) for [Ca2+] when patient-specific multivariable estimators combining QRS and T wave markers were used. Conclusion: QRS morphological markers allow non-invasive estimation of [K+] and [Ca2+] with low sensitivity to HR. The estimation performance is improved when multivariable models, including T wave markers, are considered. Significance: Markers based on the QRS complex of the ECG could contribute to non-invasive monitoring of serum electrolyte levels and arrhythmia risk prediction in patients with renal disease

Idioma: Inglés

DOI: 10.3390/s22082951

Año: 2022

Publicado en: Sensors 22 , 8 (2022), 2951 [19 pp]
ISSN: 1424-8220

Factor impacto JCR: 3.9 (2022)

Categ. JCR: CHEMISTRY, ANALYTICAL rank: 26 / 86 = 0.302 (2022) - Q2 - T1
Categ. JCR: INSTRUMENTS & INSTRUMENTATION rank: 19 / 63 = 0.302 (2022) - Q2 - T1
Categ. JCR: ENGINEERING, ELECTRICAL & ELECTRONIC rank: 100 / 274 = 0.365 (2022) - Q2 - T2

Factor impacto CITESCORE: 6.8 - Engineering (Q1) - Chemistry (Q1) - Biochemistry, Genetics and Molecular Biology (Q2) - Physics and Astronomy (Q1)

Factor impacto SCIMAGO: 0.764 - Instrumentation (Q1) - Analytical Chemistry (Q1) - Medicine (miscellaneous) (Q2) - Information Systems (Q2) - Biochemistry (Q2) - Atomic and Molecular Physics, and Optics (Q2) - Electrical and Electronic Engineering (Q2)

Financiación: info:eu-repo/grantAgreement/ES/DGA-FSE/T39-20R-BSICoS group
Financiación: info:eu-repo/grantAgreement/EUR/ERC-2014-StG-638284
Financiación: info:eu-repo/grantAgreement/EC/H2020/764738/EU/Personalised In-Silico Cardiology/PIC
Financiación: info:eu-repo/grantAgreement/ES/MICINN-FEDER/PID2019-104881RB-I00
Financiación: info:eu-repo/grantAgreement/ES/MICINN-FEDER/PID2019-105674RB-I00

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Área Ingen.Sistemas y Automát. (Dpto. Informát.Ingenie.Sistms.)
Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
Área (Departamento): Área Teoría Señal y Comunicac. (Dpto. Ingeniería Electrón.Com.)