Chronic Hemodialysis: High Risk Patients for Arrhythmias?

Abstract

Patients with end-stage kidney disease untergoing chronic maintenance dialysis (HD) are a high risk group for sudden death due to cardiovascular complications. It was the aim of the study to investigate the quantity and quality of arrhythmias during HD and between two consecutive HD (interval, I) with regard to the reproducibility of the expected results. 15 patients (8 males, 7 females) underwent continuous Holier monitoring (LT-ECG) under ambulatory conditions over 96 h including two HD (HD 1 + HD2) and two intervals (11 + 12). The LT-ECG recordings were analysed with the computer assisted ‘Multipass-Scanning’ system with regard to heart rate (HR), supraventricular premature beats (SPB), ventricular ectopics (PVC) and malignant ventricular arrhythmias. Results: The HR demonstratd a typical, well-known circadian pattern with remarkable increase of the HR during each HD. Except for rare, single SPB and/or PVC, no supraventricular or ventricular arrhythmias could be detected reproducibly. Single PVC occurred in patients with a lower potassium value. No malignant ventricular arrhythmias were found. In comparison to previously published studies, which demonstrated a high incidence of malignant ventricular arrhythmias, these conflicting results were due to differences in patients’ recruitment (unterlying disease, age, etc.), the performance of HD (duration, ion concentration of the dialysate etc.), serum potassium levels and drug medication (digitalis, quinidine). In summary, chronic HD per se did not enhance the risk of malignant arrhythmias in patients with end-stage kidney disease.

Hemodialysis-Induced Left Ventricular Dysfunction Is Associated with an Increase in Ventricular Arrhythmias

“…Previous evidence has suggested that the high incidence of ventricular arrhythmias detected in previous studies could be due to differences in patient recruitment and variables, including age, disease etiology, dialysis vintage and duration, and concomitant medication. [7] We found no such association between these variables and the frequency of PVCs or arrhythmias. Furthermore, the use of digoxin in patients on maintenance HD has been shown to increase the incidence of occult and potentially serious ventricular ectopy [23] and also potentially contribute to the high incidence of PVCs and CVAs in HD patients.…”

“…[5] Consequently, there have been a number of studies looking at the potential pro-arrhythmogenic effects of HD, which reported the frequency of dialysis induced arrhythmias as anywhere in the range of 5-75% of treatments. [6,7] The presence of both potentially life-threatening complex ventricular arrhythmias (CVAs) and premature ventricular complexes (PVCs) has been associated with increased morbidity and mortality. CVAs (defined as Lown score of 3 and above) are reported in up to 35% of HD patients during treatment [8] and associated with negative prognostic factors including new coronary events [9] and silent myocardial ischemia.…”

Study the Effect of High Dialysate Potassium Solution in Comparison to Low Potassium Dialysate Solution in End Stage Renal Disease Patients

“…In our opinion analysis of data support Rombol`a idea that some stressors such as fluid overload, increase in blood pressure and the changes in pH and bicarbonates, may act as trigger of ventricular arrhythmias [26]. Obviously this may be particularly true for patients with cardiomyopathy, left-ventricular hypertrophy, coronary artery disease and cardiac heart failure, which provide the perfect backdrop for arrhythmias to occur [27].…”

Acute Complications of Hemodialysis

“…Finally, the drugs used by some of the patients receiving anti-arrhythmic therapy may also be dialyzable. Such patients may, for this reason, be susceptible to arrhythmia during or after hemodialysis (Kimura et al,1989;Weber et al, 1984). Prevalence of atrial fibrillation as one of the arrhythmia types was reported to be 27%, which is way above 0.5-1% seen in the general population (Genovesi et al,2008).…”