Intradialytic Arrhythmias Among Patients with End Stage Renal Disease on Maintenance Hemodialysis at Muhimbili National Hospital

Abstract

BackgroundArrhythmias are responsible for almost 2 out of 3 cardiac deaths among patients on hemodialysis. We report the prevalence and risk factors for clinically significant arrhythmias among end stage renal disease (ESRD) patients on maintenance dialysis at a tertiary dialysis facility in Tanzania. MethodsCross-sectional study, involving consenting adults with ESRD was conducted September 2019 to February 2020. Arrhythmias were assessed using standard 5-leads Holter electrocardiography placed 15 minutes before dialysis and connected throughout dialysis. Clinically Significant Arrhythmias (CSA) was defined as ectopic beats in excess of 10 per hour or any of the ventricular tachycardia or Pause lasting for at least 2.5 seconds or paroxysmal supraventricular tachycardia or atrial flutter or atrial fibrillation. ResultsA total of 71 (44.4%) participants had CSA. Factors associated with increased risk for CSA were: age older than 60 years (OR 34; 95% CI: 5.15-236; P< 0.001), intradialytic blood pressure change of ≥ 10mmHg (OR 3.85; 95% CI: 1.27-11.7; P=0.017) and the presence of Left Ventricular Hypertrophy (OR 5.84; 95% CI: 1.85-18.4; P< 0.01). On the contrary, three dialysis sessions per week (OR 0.14; 95% CI: 0.03-0.67; P=0.013) and use of beta-blockers (OR 0.18; 95% CI: 0.05-0.68; P=0.011) were significantly associated with a decreased risk of CSA. ConclusionClinically significant arrhythmias are not uncommon in ESRD patients undergoing maintenance haemodialysis. We recommend increasing vigilance for CSA among older patients (>60 years) as well as those with left ventricular hypertrophy. Beta blockers among hypertensive ESRD patients with ventricular hypertrophy could be helpful.

Evaluation of the risk factors of hemodialysis procedure-associated cardiac arrhythmias in end stage renal disease Egyptian patients

“…(12) Also, the majority of the participant in Adam et al and Mahmood et al study (78.8% and 59.16% respectively) had hypertension. (9,13) Which is consistent with our study results, this could be due to the closer sample size in these studies and our study.…”

“…In Adam et al cross sectional study of intradialytic arrhythmias among patients with ESRD on maintenance HD, the prevalence of arrhythmia was 92% . (9) Similarly, in Al-Ameen et al study, the prevalence of arrhythmia was 84% among the HD patients. (10) The relatively close numbers in the previous two studies and our study may be due to the close number of the sample size and the usage of the same method (halter) in recording the occurrence of arrhythmia.…”

“…In contrast, Adam et al reported that ESRD patients, 60 years or older, were 34 times more likely to present with intradialytic clinically significant arrhythmia compared to those aged 20 -39 years (OR 34; 95% CI: 5.15-236; P< 0.001). (9) This could be explained by that hemodialysis is associated with hemodynamic changes and autonomic imbalance which predispose the myocardium to arrhythmias. It was found that youths and young adults are likely to tolerate these physiological changes, on other hand, older adults are less likely to tolerate these changes and are prone to suffer from arrhythmias.…”

“…Also, patients doing less than three sessions per week had relatively higher water retention compared to those doing three sessions, which is a risk factor for developing arrhythmia. (9) Rogovoy et al added to the growing evidence of the harmful consequences of a prolonged interdialytic interval. He stated that while every-other-day hemodialysis preserved relatively normal cardiovascular autonomic tone, a second day without hemodialysis was characterized by parasympathetic withdrawal and a steady increase in sympathetic predominance, which may explain the previously observed increased rate of SCD after the long interdialytic interval.…”

Is the magnesium phosphate ratio a predictor of arrhythmia in patients undergoing hemodialysis?

“…In a study of 160 patients with end-stage renal disease receiving hemodialysis, 92% of arrhythmic events were detected. The frequency of these arrhythmias was mostly ventricular events with 81%, followed by supraventricular events with 51% (30). Similar to previous studies by Sforzini et al (31), the most common arrhythmia in our study was ventricular events (37% among all arrhythmias).…”