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BackgroundLeft ventricular hypertrophy is the most prevalent cardiac abnormality in patients on hemodialysis. This abnormality can be diagnosed by electrocardiography and/or echocardiography. Our study aimed to assess the prevalence of left ventricular hypertrophy in hemodialysis patients, and the accuracy of different electrocardiographic criteria.MethodsThis was a cross-sectional retrospective study including 60 hemodialysis patients between 2017 and 2018. A left ventricular mass index higher than 115g/m2 and 95g/m2 in men and women respectively was used to define echocardiographic left ventricular hypertrophy. We assessed the prevalence of left ventricular hypertrophy, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve for fourteen different electrocardiographic criteria for identifying left ventricular hypertrophy.ResultsThis was a cohort of 60 patients consisting of 27 men and 33 women with a mean age of 52.6±15.8 years. Hypertension was the most common cardiovascular risk factor (82%). The prevalence of echocardiographic left ventricular hypertrophy was 65%. The prevalence of electrocardiographic left ventricular hypertrophy varied across the different criteria, ranging from 5% (R wave in DI) to 32% (Perugia score). The highest prevalence of electrocardiographic left ventricular hypertrophy was observed with the five following criteria: Perugia score (32%), Peguero-Lo Presti index (28%), Sokolow-Lyon index, Cornell index, and Framingham-adjusted Cornell voltage (17%). Sensitivity ranged from 5% (R in DI, Gubner-Ungerleider index and product) to 41% (Perugia score). The specificity of most of the criteria was ≥90%, except for the Perugia score (85%). The sensitivity, specificity, positive and negative predictive values, and prevalence of left ventricular hypertrophy using the five most accurate criteria combined were 48%, 90%, 70.28%, 77.85%, and 33% respectively. Hypertension, duration of hemodialysis, arteriovenous fistula, interdialytic weight gain, systolic blood pressure, hemoglobin ConclusionThe prevalence of echocardiographic left ventricular hypertrophy was high. All of the electrocardiographic criteria had low sensitivity and high specificity. To improve the accuracy of electrocardiographic criteria, it is necessary to combine several electrocardiographic criteria rather than focus on a single classic electrocardiographic index.