Peaked T-Waves and Potassium: The Reliability of Peaked T-Waves as Indicators of Hyperkalemia in End-Stage Renal Patients Undergoing Hemodialysis

While peaked T-waves have traditionally been associated with hyperkalemia cases, previous studies have called their reliability for hyperkalemia diagnosis into question. This study examined 89 ESRD patients totaling to 736 patient visits. Linear regressions and receiver operating characteristic (ROC) analyses were utilized to assess the reliability of peaked T-waves as a diagnostic criterion for hyperkalemia. Poor correlations between T/R ratio (leads V2-V4) and serum potassium were found, r = 0.23, 0.17, and 0.17, < 0.001. R2 values ranged from 0.03 to 0.05. ROC analysis found poor sensitivity and specificity of T/R as a predictor of hyperkalemia (area under the curve: 0.61 – 0.66), threshold yielded a sensitivity of 0.83 with a specificity of 0.40 when predicting hyperkalemia (serum potassium > 5.5 mEq/L). We conclude that the peaked T-wave is a poor indicator for the early identification of hyperkalemia in ESRD patients presenting to the emergency department.