doi:10.1038/s41598-021-82935-5engPalmieri, F.Gomis, P.Ferreira, D.Ruiz, J.E.Bergasa, B.Martín-Yebra, A.Bukhari, H.A.Pueyo, E.Martínez, J.P.Ramírez, J.Laguna, P.Monitoring blood potassium concentration in hemodialysis patients by quantifying T-wave morphology dynamicsART-2021-123129We investigated the ability of time-warping-based ECG-derived markers of T-wave morphology changes in time (dw) and amplitude (da), as well as their non-linear components (dNLw and dNLa), and the heart rate corrected counterpart (dw,c), to monitor potassium concentration ([K+]) changes (Δ[K+]) in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). We compared the performance of the proposed time-warping markers, together with other previously proposed [K+] markers, such as T-wave width (Tw) and T-wave slope-to-amplitude ratio (TS/A), when computed from standard ECG leads as well as from principal component analysis (PCA)-based leads. 48-hour ECG recordings and a set of hourly-collected blood samples from 29 ESRD-HD patients were acquired. Values of dw, da, dNLw, dNLa and dw,c were calculated by comparing the morphology of the mean warped T-waves (MWTWs) derived at each hour along the HD with that from a reference MWTW, measured at the end of the HD. From the same MWTWs Tw and TS/A were also extracted. Similarly, Δ[K+] was calculated as the difference between the [K+] values at each hour and the [K+] reference level at the end of the HD session. We found that dw and dw,c showed higher correlation coefficients with Δ[K+] than TS/A—Spearman’s (ρ) and Pearson’s (r)—and Tw—Spearman’s (ρ)—in both SL and PCA approaches being the intra-patient median ρ≥0.82 and r≥0.87 in SL and ρ≥0.82 and r≥0.89 in PCA respectively. Our findings would point at dw and dw,c as the most suitable surrogate of Δ[K+], suggesting that they could be potentially useful for non-invasive monitoring of ESRD-HD patients in hospital, as well as in ambulatory settings. Therefore, the tracking of T-wave morphology variations by means of time-warping analysis could improve continuous and remote [K+] monitoring of ESRD-HD patients and flagging risk of [K+]-related cardiovascular events.2021http://zaguan.unizar.es/record/9969010.1038/s41598-021-82935-5http://zaguan.unizar.es/record/99690oai:zaguan.unizar.es:99690info:eu-repo/grantAgreement/ES/CIBER-BBN/DEKOALEinfo:eu-repo/grantAgreement/ES/DGA-FSE/Building Europe from Aragoninfo:eu-repo/grantAgreement/ES/DGA-FSE/T39-20R-BSICoS groupinfo:eu-repo/grantAgreement/ES/DGA/LMP124-18info:eu-repo/grantAgreement/EUR/ERC-2014-StG-638284info:eu-repo/grantAgreement/ES/MICINN-FEDER/PID2019-104881RB-I00info:eu-repo/grantAgreement/ES/MICINN-FEDER/PID2019-105674RB-I00Scientific reports (Nature Publishing Group) 11, 1 (2021), 3883 [15 pp]byhttp://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccess