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End-stage renal disease (ESRD) patients undergoing hemodialysis (HD) are at high risk of arrhythmias and sudden cardiac death as a result of blood potassium concentration ([K +  ]) changes. The aim of this study is to investigate if d w , a time-warping-based electrocardiogram (ECG) biomarker of T-wave morphology changes, reflects [K + ] evolution in HD patients, facilitating noninvasive [K + ] monitoring and avoiding in-hospital blood tests analysis. 48-hour ECGs and a set of hourly-collected blood samples from 12 ESRD patients were acquired and analyzed. d w  was calculated between a reference T-wave, measured at the end of the HD session, and the T-waves corresponding to each hour along the whole HD session, when [K + ] was measured from blood samples. The values of d w  correlated with the relative variations in [K + ] with respect to the reference value (end of HD, &#x0394;[K +  ]), with a median (interquartile) correlation coefficient of 0.90 (0.30), evidencing a strong relation between them. Our findings support the use of d w  as a surrogate of &#x0394;[K + ], suggesting a potential use of d w  for non-invasive hyperkalemia monitoring both in hospital and ambulatory settings.

T-Wave Morphology Changes as Surrogate for Blood Potassium Concentration in Hemodialysis Patients