{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T13:52:16Z","timestamp":1771854736310,"version":"3.50.1"},"reference-count":63,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T00:00:00Z","timestamp":1649721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","award":["Marie Sk\u0142odowska- Curie grant 764738"],"award-info":[{"award-number":["Marie Sk\u0142odowska- Curie grant 764738"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004837","name":"Ministerio de Ciencia e Innovaci\u00f3n","doi-asserted-by":"publisher","award":["PID2019-105674RBI00 and PID2019-104881RB-I00"],"award-info":[{"award-number":["PID2019-105674RBI00 and PID2019-104881RB-I00"]}],"id":[{"id":"10.13039\/501100004837","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000781","name":"European Research Council","doi-asserted-by":"publisher","award":["ERC-StG 63828"],"award-info":[{"award-number":["ERC-StG 63828"]}],"id":[{"id":"10.13039\/501100000781","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European Social Fund (EU) and Arag\u00f3n Government","award":["LMP94 21 and BSICoS group T39 20R"],"award-info":[{"award-number":["LMP94 21 and BSICoS group T39 20R"]}]},{"DOI":"10.13039\/501100001665","name":"French National Research Agency","doi-asserted-by":"publisher","award":["grant reference ANR-10-IAHU04-LIRYC"],"award-info":[{"award-number":["grant reference ANR-10-IAHU04-LIRYC"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Objective: Non-invasive estimation of serum potassium, [K+], and calcium, [Ca2+], can help to prevent life-threatening ventricular arrhythmias in patients with advanced renal disease, but current methods for estimation of electrolyte levels have limitations. We aimed to develop new markers based on the morphology of the QRS complex of the electrocardiogram (ECG). Methods: ECG recordings from 29 patients undergoing hemodialysis (HD) were processed. Mean warped QRS complexes were computed in two-minute windows at the start of an HD session, at the end of each HD hour and 48 h after it. We quantified QRS width, amplitude and the proposed QRS morphology-based markers that were computed by warping techniques. Reference [K+] and [Ca2+] were determined from blood samples acquired at the time points where the markers were estimated. Linear regression models were used to estimate electrolyte levels from the QRS markers individually and in combination with T wave morphology markers. Leave-one-out cross-validation was used to assess the performance of the estimators. Results: All markers, except for QRS width, strongly correlated with [K+] (median Pearson correlation coefficients, r, ranging from 0.81 to 0.87) and with [Ca2+] (r ranging from 0.61 to 0.76). QRS morphology markers showed very low sensitivity to heart rate (HR). Actual and estimated serum electrolyte levels differed, on average, by less than 0.035 mM (relative error of 0.018) for [K+] and 0.010 mM (relative error of 0.004) for [Ca2+] when patient-specific multivariable estimators combining QRS and T wave markers were used. Conclusion: QRS morphological markers allow non-invasive estimation of [K+] and [Ca2+] with low sensitivity to HR. The estimation performance is improved when multivariable models, including T wave markers, are considered. Significance: Markers based on the QRS complex of the ECG could contribute to non-invasive monitoring of serum electrolyte levels and arrhythmia risk prediction in patients with renal disease.<\/jats:p>","DOI":"10.3390\/s22082951","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T22:48:45Z","timestamp":1649803725000},"page":"2951","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Monitoring of Serum Potassium and Calcium Levels in End-Stage Renal Disease Patients by ECG Depolarization Morphology Analysis"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5976-0483","authenticated-orcid":false,"given":"Hassaan A.","family":"Bukhari","sequence":"first","affiliation":[{"name":"BSICoS Group, I3A Institute, IIS Arag\u00f3n, University of Zaragoza, 50018 Zaragoza, Spain"},{"name":"CIBER en Bioingenier\u00eda, Biomateriales y Nanomedicina (CIBER-BBN), 50018 Zaragoza, Spain"},{"name":"Carmen Team, Inria Bordeaux\u2014Sud-Ouest, 33405 Talence, France"},{"name":"Universit\u00e9 de Bordeaux, IMB, UMR 5251, 33400 Talence, France"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4273-5403","authenticated-orcid":false,"given":"Carlos","family":"S\u00e1nchez","sequence":"additional","affiliation":[{"name":"BSICoS Group, I3A Institute, IIS Arag\u00f3n, University of Zaragoza, 50018 Zaragoza, Spain"},{"name":"CIBER en Bioingenier\u00eda, Biomateriales y Nanomedicina (CIBER-BBN), 50018 Zaragoza, Spain"}]},{"given":"Jos\u00e9 Esteban","family":"Ruiz","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Cl\u00ednico Universitario Lozano Blesa, 50009 Zaragoza, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4166-2687","authenticated-orcid":false,"given":"Mark","family":"Potse","sequence":"additional","affiliation":[{"name":"Carmen Team, Inria Bordeaux\u2014Sud-Ouest, 33405 Talence, France"},{"name":"Universit\u00e9 de Bordeaux, IMB, UMR 5251, 33400 Talence, France"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3434-9254","authenticated-orcid":false,"given":"Pablo","family":"Laguna","sequence":"additional","affiliation":[{"name":"BSICoS Group, I3A Institute, IIS Arag\u00f3n, University of Zaragoza, 50018 Zaragoza, Spain"},{"name":"CIBER en Bioingenier\u00eda, Biomateriales y Nanomedicina (CIBER-BBN), 50018 Zaragoza, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1960-407X","authenticated-orcid":false,"given":"Esther","family":"Pueyo","sequence":"additional","affiliation":[{"name":"BSICoS Group, I3A Institute, IIS Arag\u00f3n, University of Zaragoza, 50018 Zaragoza, Spain"},{"name":"CIBER en Bioingenier\u00eda, Biomateriales y Nanomedicina (CIBER-BBN), 50018 Zaragoza, Spain"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e004667","DOI":"10.1161\/CIRCEP.116.004667","article-title":"Electrophysiology of hypokalemia and hyperkalemia","volume":"10","author":"Weiss","year":"2017","journal-title":"Circ. 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