Ventricular ECG Abnormalities as a Predictor of Mortality Outcomes in Non-Dialysis Chronic Kidney Disease Patients

Background: About half of the mortality of patients with chronic kidney disease (CKD) was attributable to cardiovascular causes, as evidenced by cardiac structural remodeling that could be detected on a surface electrocardiogram (ECG). However, the ability of ECG abnormalities to predict survival outcomes in CKD patients remained inconclusive. Objective: To identify the ventricular ECG abnormalities that could predict long-term mortality in non-dialysis CKD patients with cardiovascular risks. Materials and Methods: The authors conducted an analysis of data from the CORE-CKD (Thailand) registry, which included pre-dialysis CKD patients with cardiovascular risks. Baseline demographic data and co-morbidities were recorded. All baseline ECG were reviewed to determine the pertinent ventricular ECG abnormalities, including three voltage criteria for ventricular hypertrophy (Cornell, Sokolow-Lyon, and Peguro-Lo Presti criteria), QRS duration, bundle branch block, left anterior and posterior fascicular block, QT interval, QRS and T wave angle, QRS-T angle, poor R wave progression in chest leads, and pathological Q wave. Cox regression analysis was utilized to estimate the prognostic value of all relevant ECG parameters for survival. Results: The baseline 12-lead ECG and complete long-term outcome data were available for 251 patients. Median age was 66, with an IQR of 59 to 70 years. Median eGFR was 36.35 (27.78 to 46.43) mL/minute/1.73 m² with diabetic nephropathy accounting for the majority of cases. Thirteen patients (5.1%) died during the median follow-up of 58.4 (29.0 to 61.1) months. After Cox regression analysis adjusted with potential confounding factors including age and gender, Cornell’s criteria for left ventricular hypertrophy (LVH) (adjusted HR 7.94, 95% CI 1.58 to 39.85, p=0.012) and left posterior fascicular block (LPFB) (adjusted HR 11.33, 95% CI 1.40 to 91.32, p=0.039) were associated with increased risk of all-cause mortality. Conclusion: LVH by Cornell voltage criteria and LPFB were associated with an increased risk of all-cause mortality in pre-dialysis CKD patients with cardiovascular risks.