Rates of Cardiac Rhythm Abnormalities in Patients with CKD and Diabetes

Abstract

Background and objectivesCardiac arrhythmias increase mortality and morbidity in CKD. We evaluated the rates of subclinical arrhythmias in a population with type 2 diabetes and patients with moderate to severe CKD who were not on dialysis.Design, setting, participants & measurementsThis is a prospective observational study, using continuous ambulatory cardiac monitors to determine the rate of atrial and ventricular arrhythmias, as well as conduction abnormalities in this group.ResultsA total of 38 patients (34% women), with mean eGFR of 38±13 ml/min per 1.73 m2, underwent ambulatory cardiac monitoring for 11.2±3.9 days. The overall mean rate of any cardiac arrhythmia was 88.8 (95% confidence interval [95% CI], 27.1 to 184.6) episodes per person-year (PY). A history of cardiovascular disease was associated with a higher rate of detected arrhythmia (rate ratio, 5.87; 95% CI, 1.37 to 25.21; P<0.001). The most common arrhythmia was atrial fibrillation, which was observed in two participants with known atrial fibrillation and was a new diagnosis in four patients (11%), none of whom experienced symptoms. Overall, atrial fibrillation episodes occurred at a rate of 37.6 (95% CI, 2.4 to 112.3) per PY. Conduction abnormalities were found in eight patients (21%), a rate of 26.5 (95% CI, 4.2 to 65.5) per PY. Rates of ventricular arrhythmias were low (14.5 per PY; 95% CI, 4.3 to 32.0) and driven by premature ventricular contractions.ConclusionsCardiac rhythm abnormalities are common in patients with diabetes with moderate to severe CKD not requiring dialysis. Rates of atrial fibrillation are high and episodes are asymptomatic. Future studies are needed to determine the role of screening and upstream therapy of cardiac arrhythmias in this group.

Risk of atrial fibrillation in persons with type 2 diabetes and the excess risk in relation to glycaemic control and renal function: a Swedish cohort study

“…Since rates of diabetes mellitus and atrial fibrillation are increasing worldwide and are strong risk factors for stroke and cardiovascular mortality due to thromboembolic risk, it is important to consider early prevention. In a prospective observational study, cardiac rhythm abnormalities were common in patients with moderate to severe CKD not requiring dialysis [27]. Therefore, strategies to prevent renal complications with blood pressure control should be viewed as a goal for protection, both for renal and cardiovascular diseases.…”

Chronic kidney disease and undiagnosed atrial fibrillation in individuals with diabetes

“…In our study, 17 patients among 19 new cases of AF did not have any symptom and 2 patients experienced only mild symptoms that didn't cause them to seek medical care. Similarly, in other study reporting the newly diagnosed AF among patients with CKD and diabetes using ambulatory cardiac monitoring none of the newly diagnosed patients have experienced any symptoms [14]. In study of 77 dialysis patients, 38% of supraventricular arrhythmias (SVA) including 14% of AF were observed during dialysis, which were all asymptomatic and the SVA associated with a fourfold increased risk of cardiovascular events.…”

“…In our study, CKD was significantly associated with greater risk of incident AF among individuals with diabetes, which was consistent with previous reports. Akoum et al [14] reported that 11% of newly diagnosed AF for 11.2 days of monitoring period using ambulatory cardiac monitoring among 38 patients with CKD and diabetes. It is higher than the result of our study that 7.3% of newly diagnosed AF was reported for 1 year of follow up period.…”

“…It can improve the poor cardiovascular outcomes in patients with CKD. There are a few studies assessing preclinical AF in patients with ESRD requiring hemodialysis [8,11,12], and in patients with CKD not receiving dialysis [13,14]. Recently, with the availability of noninvasive mobile cardiac monitors, there is an opportunity to characterize the incidence and burden of preclinical AF in large populations.…”

Temporal Relationship of Glycemia With Cardiac Arrhythmias in Patients With Type 2 Diabetes and CKD

“…We demonstrated that hypoglycemia is common in patients with chronic kidney disease (CKD) and T2D; 5 and these patients have high rates of cardiac arrythmias. 6 However, the association of glycemia with arrythmias in patients with CKD and T2D remains poorly elucidated; and even small relative differences in glucose may be important. Using continuous glucose monitoring (CGM) and mobile cardiac telemetry, there are new opportunities to characterize the temporality of glycemia with onset of an arrhythmia.…”