Primary outcomes of the Monitoring in Dialysis Study indicate that clinically significant arrhythmias are common in hemodialysis patients and related to dialytic cycle

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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.

Original languageEnglish (US)
Pages (from-to)941-951
Number of pages11
JournalKidney international
Volume93
Issue number4
DOIs
StatePublished - Apr 2018

Bibliographical note

Funding Information:
The authors would like to thank Ven Manda, John Burnes, and Amy Roettger from Medtronic for support and collaboration on the MiD study and Jason Cai and Candace McClure from NAMSA for statistical support. The MiD study was funded by Medtronic.

Funding Information:
All the authors received significant research support and/or consulting fees from Medtronic in relationship to the design and conduct of the study. DMC has received expert witness fees (significant) related to dialysate composition from Fresenius, research support from Medtronic, research support and consulting fees (modest) related to services on trial steering committee from Zoll Medical, and consulting fees (modest) from Medtronic. AIC has participated on the speaker’s bureau for Biotronik and Biosense Webster. VK has received research funding from Novartis India, Sanofi Aventis India, and Astellas India; has received honoraria from Novartis India, Roche India, Astellas India, Torrent India, and Reddy’s India; has acted as a scientific advisor for Roche India, Novartis India, Torrent, Sanofi Aventis, Reddy’s India, Biocon India, and Medtronic; and has participated on the speakers bureau for Novartis India, Roche India, Panacea India, Sanofi Aventis India, Intas India, Biocon India, Pfizer, and Medtronic. PR-C has participated as a consultant or on the advisory board for Medtronic, Bard Peripheral Vascular, WL Gore, Akebia, TVA, Cormedix, Humacyte, and Proteon.

Publisher Copyright:
© 2017 International Society of Nephrology

Keywords

  • arrhythmia
  • cardiovascular disease
  • end-stage renal disease
  • hemodialysis
  • sudden death

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