1. Primary outcomes of the Monitoring in Dialysis Study indicate that clinically significant arrhythmias are common in hemodialysis patients and related to dialytic cycle
- Author
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Prabir Roy-Chaudhury, Jim A. Tumlin, Bruce A. Koplan, Alexandru I. Costea, Vijay Kher, Don Williamson, Saurabh Pokhariyal, David M. Charytan, James Tumlin, Vikranth Reddy, Kowdle Chandrasekhar Prakash, David Charytan, Suresh Chandra Tiwari, Amber Podoll, Sanjeev Jasuja, G. Leslie Walters, Kraig Wangsnes, Alexandru Costea, Selcuk Tombul, Balbir Singh, Brajesh Mishra, Sachin Yalagudri, Abhijeet Shelke, Calambur Narasimhan, A.M. Karthigesan, Abraham Oomman, K.P. Pramod Kumar, Bruce Koplan, Upendra Kaul, Tapan Ghose, Ripen Gupta, Arvind Sethi, Nikhil Kumar, Ramesh Hariharan, Rajnish Sardana, Arif Wahab, N.N. Khanna, Mark Smith, Suresh Kamath, Claude Galphin, Puneet Sodhi, Rajsekara Chakravarthy, Subba Rao Budithi, Finnian McCausland, Sanjeev Gulati, Munawer Dijoo, Upendra Singh, Salil Jain, Vishal Saxena, Gaurav Sagar, Rachel Fissell, Robert Foley, Charles A. Herzog, Peter McCullough, John D. Rogers, James A. Tumlin, Peter Zimetbaum, Manish Assar, Mark Kremers, and Wolfgang C. Winkelmayer
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Adult ,Male ,Bradycardia ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,030232 urology & nephrology ,India ,030204 cardiovascular system & hematology ,Ventricular tachycardia ,Risk Assessment ,Sudden death ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Renal Dialysis ,Risk Factors ,Dialysis Solutions ,Internal medicine ,medicine ,Humans ,Prospective Studies ,cardiovascular diseases ,Asystole ,Dialysis ,Aged ,business.industry ,Incidence ,Sodium ,Arrhythmias, Cardiac ,Atrial fibrillation ,Middle Aged ,medicine.disease ,United States ,Death, Sudden, Cardiac ,Treatment Outcome ,Nephrology ,cardiovascular system ,Cardiology ,Kidney Failure, Chronic ,Calcium ,Female ,Hemodialysis ,medicine.symptom ,business ,Biomarkers - Abstract
Sudden death is one of the more frequent causes of death for hemodialysis patients, but the underlying mechanisms, contribution of arrhythmia, and associations with serum chemistries or the dialysis procedure are incompletely understood. To study this, implantable loop recorders were utilized for continuous cardiac rhythm monitoring to detect clinically significant arrhythmias including sustained ventricular tachycardia, bradycardia, asystole, or symptomatic arrhythmias in hemodialysis patients over six months. Serum chemistries were tested pre- and post-dialysis at least weekly. Dialysis procedure data were collected at every session. Associations with clinically significant arrhythmias were assessed using negative binomial regression modeling. Sixty-six patients were implanted and 1678 events were recorded in 44 patients. The majority were bradycardias (1461), with 14 episodes of asystole and only one of sustained ventricular tachycardia. Atrial fibrillation, although not defined as clinically significant arrhythmias, was detected in 41% of patients. With thrice-weekly dialysis, the rate was highest during the first dialysis session of the week and was increased during the last 12 hours of each inter-dialytic interval, particularly the long interval. Among serum and dialytic parameters, only higher pre-dialysis serum sodium and dialysate calcium over 2.5 mEq/L were independently associated with clinically significant arrhythmias. Thus, clinically significant arrhythmias are common in hemodialysis patients, and bradycardia and asystole rather than ventricular tachycardia may be key causes of sudden death in hemodialysis patients. Associations with the temporal pattern of dialysis suggest that modification of current dialysis practices could reduce the incidence of sudden death.
- Published
- 2018
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