대한신장학회

논문분류	춘계학술대회 초록집
제목	Potassium-Driven Dynamic ECG Changes and Hemodynamic Correlates Detected by Wearable ECG in Maintenance Hemodialysis Patients
저자	Kyungho Park
출판정보	2026; 2026(1):
키워드	Hemodialysis, Wearable electrocardiography, Hyperkalemia, Intradialytic monitoring, Repolarization dynamics
초록	Objectives: Hyperkalemia is a life-threatening complication in dialysis patients, but real-time detection remains challenging. Wearable single-lead ECG enables continuous intradialytic monitoring; however, its relationship with dynamic electrolyte and hemodynamic parameters remains undercharacterized. We investigated associations between wearable ECG-derived intradialytic parameters and pre-dialysis potassium and hemodynamic changes in maintenance hemodialysis patients. Methods: In this prospective observational study, 32 clinically stable maintenance hemodialysis patients (≥3 months stable) were enrolled (126 sessions; median 4/patient). A wearable single-lead ECG device (HiCardi) was applied throughout each session. ECG parameters were extracted from early/late 20-minute windows, best-quality 5-minute segments within the first/last hour, delta values (late minus early), and intradialytic slope (linear regression). Associations with pre-dialysis potassium, phosphate, calcium, hemoglobin, and intradialytic blood pressure were assessed by Pearson correlation and linear mixed-effects models with patient-level random intercepts. Results: Pre-dialysis potassium (5.00±0.59 mEq/L) showed no association with static ECG amplitudes, but significant inverse associations with dynamic parameters: delta T-wave amplitude (β=−18.74, p=0.003; r=−0.28, p=0.002) and T-wave amplitude slope (β=−0.103, p=0.015; r=−0.22, p=0.012), indicating greater T-wave attenuation in higher-potassium sessions. Hemodynamically, higher mean blood pressure correlated with greater T-wave duration slope (r=+0.41, p<0.001) and slower R-amplitude decline (r=−0.28, p=0.002); lower blood pressure with prolonged late PR interval (r=−0.25, p=0.006), consistent with conduction delay under hemodynamic stress. In exploratory analyses, phosphate showed modest associations with QRS duration and ST segment (r=0.31–0.37), potentially reflecting chronic structural remodeling rather than acute electrophysiologic effects; calcium with PR interval (r=+0.31, p<0.001); and hemoglobin with P-wave amplitude (r=+0.24, p=0.006). Conclusion: Wearable ECG dynamic parameters — particularly delta T-wave amplitude and intradialytic slope — detect potassium-related repolarization changes more sensitively than static measurements in hemodialysis patients. Hemodynamic instability was independently reflected in T-wave duration and PR interval changes. These findings support continuous wearable ECG monitoring for real-time electrolyte and hemodynamic surveillance during dialysis, warranting further validation in larger cohorts.
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