The dialysis procedure as a trigger for atrial fibrillation: new insights in the development of atrial fibrillation in dialysis patients

Buiten, Maurits S.; Bie, Míhàly K. de; Rotmans, Joris I.; Gabreëls, B A Th F; Dorp, Wim van; Wolterbeek, Ron; Trines, Serge A.; Schalij, Martin J.; Jukema, J. Wouter; Rabelink, Ton J.; Erven, Lieselot van

doi:10.1136/heartjnl-2013-305417

Cited by 102 publications

(69 citation statements)

References 29 publications

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“…AF was detected in 14 of 40 dialysis patients-11 receiving HD, 3 receiving peritoneal dialysis, and 9 without known AF (54). AF frequency was three-fold higher on dialysis days (P50.001) but did not differ with duration of the interdialytic interval.…”

Section: Dialysis As a Triggermentioning

confidence: 93%

Arrhythmia and Sudden Death in Hemodialysis Patients

Charytan

Foley

McCullough

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background Dialysis patients have high rates of cardiovascular morbidity and mortality, but data on arrhythmia burden, arrhythmia type, arrhythmia triggers, and the identity of terminal arrhythmias have historically been limited by an inability to monitor heart rhythm for prolonged periods.Objectives To investigate arrhythmia and its association with sudden death in dialysis-dependent ESRD, describe the potential for implantable devices to advance study of dialysis physiology, review the ethical implications of using implantable devices in clinical studies, and report on the protocol and baseline results of the Monitoring in Dialysis Study (MiD).Design, setting, participants, & measurements In this multicenter, interventional-observational, prospective cohort study, we placed implantable loop recorders in patients undergoing long-term hemodialysis. The proportion of patients experiencing clinically significant arrhythmias was the primary endpoint. For 6 months, we captured detailed data on the primary endpoint, symptomatic arrhythmias, other electrocardiographic variables, dialysis prescription, electrolytes, dialysis-related variables, and vital signs. We collected additional electrocardiographic data for up to 1 year.Results Overall, 66 patients underwent implantation in sites in the United States and India. Diabetes was present in 63.6% of patients, 12.1% were age $70 years, 69.7% were men, and 53.0% were black. Primary and secondary endpoint data are expected in 2016.Conclusions Cardiac arrhythmia is an important contributor to cardiovascular morbidity and mortality in dialysis patients, but available technology has previously limited the ability to estimate its true burden and triggers and to define terminal rhythms in sudden death. Use of implantable technology in observational studies raises complex issues but may greatly expand understanding of dialysis physiology. The use of implantable loop recorders in MiD is among the first examples of such a trial, and the results are expected to provide novel insights into the nature of arrhythmia in hemodialysis patients.

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Section: Dialysis As a Triggermentioning

confidence: 93%

Arrhythmia and Sudden Death in Hemodialysis Patients

Charytan

Foley

McCullough

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…Hemodialysis favors the initiation of AF through rapid shifts in fluid and electrolytes (potassium), and episodes of AF are common during hemodialysis. 20 Although hemodialysis-induced AF may contribute to the increase in stroke risk observed in those initiating dialysis, it must be acknowledged that patients are anticoagulated during their dialysis sessions. Therefore, it is possible that hemodialysis-related AF may carry a lower risk of stroke than AF in the general population.…”

Section: Risk Factors For Strokementioning

confidence: 99%

Risk Factors of Ischemic Stroke and Subsequent Outcome in Patients Receiving Hemodialysis

Findlay

Thomson

Fulton

et al. 2015

Stroke

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Background and Purpose— End-stage renal disease (ESRD) requiring hemodialysis carries up to a 10-fold greater risk of stroke than normal renal function. Knowledge on risk factors and management strategies derived from the general population may not be applicable to those with ESRD. We studied a large ESRD population to identify risk factors and outcomes for stroke. Methods— All adult patients receiving hemodialysis for ESRD from January 1, 2007, to December 31, 2012, were extracted from the electronic patient record. Variables associated with stroke were identified by survival analysis; demographic, clinical, imaging, and dialysis-related variables were assessed, and case-fatality was determined. Follow-up was until December 31, 2013. Results— A total of 1382 patients were identified (mean age, 60.5 years; 58.5% men). The prevalence of atrial fibrillation was 21.2%, and 59.4% were incident hemodialysis patients. One hundred and sixty patients (11.6%) experienced a stroke during 3471 patient-years of follow-up (95% ischemic). Stroke incidence was 41.5/1000 patient-years in prevalent and 50.1/1000 patient-years in incident hemodialysis patients. Factors associated with stroke on regression analysis were prior stroke, diabetes mellitus, and age at starting renal replacement therapy. Atrial fibrillation was not significantly associated with stroke, and warfarin did not affect stroke risk in warfarin-treated patients. Fatality was 18.8% at 7 days, 26.9% at 28 days, and 56.3% at 365 days after stroke. Conclusions— Incidence of stroke is high in patients with ESRD on hemodialysis with high case-fatality. Incident hemodialysis patients had the highest stroke incidence. Many, but not all, important risk factors commonly associated with stroke in the general population were not associated with stroke in patients receiving hemodialysis.

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“…20 Buiten and associates reported that the risk of atrial fibrillation was 7-fold higher during than before dialysis, implicating intravascular depletion as a potential mechanism. They also observed a correlation with dialysate potassium concentration, suggesting electrolyte shifts as a possible cause.…”

Section: Discussionmentioning

confidence: 99%

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Shaikh

Karipineni

Parsikia

et al. 2015

Exp Clin Transplant

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Objectives: Grafts from extended criteria donors, donors after cardiac death, and elderly donors have an increased risk of delayed graft function, lower graft survival, longer hospital stay, higher costs, and increased medical sequelae. A modifiable risk factor for delayed graft function may be the performance of dialysis on the same day as renal transplant. We reviewed our institutional experience to determine whether dialysis performed within 24 hours of engraftment increased the incidence or length of delayed graft function. Materials and Methods: We retrospectively reviewed our kidney transplants performed between 2008 and 2012. Preemptive transplants, transplants associated with peritoneal dialysis, potassium > 5 mmol/L, or living donors, and cases with insufficient information were excluded. Data collected included demographic, biochemical, donor, operative, and outcome variables (length of stay, length of delayed graft function, rejection, and a composite unfavorable outcome comprising cardiac and infectious events). Transplants that were associated with hemodialysis within 24 hours before transplant (study group) were compared with the remainder of the cohort (control group). Results: A total of 205 renal transplants were reviewed. There were 144 of 205 transplants (70.24%) in the study group, and the others comprised the control group. The rate of delayed graft function was 31% for the study group and 29% for control groups (P = .4959). Mean length of delayed graft function was 5.8 days for the study group and 6.1 days for control group (P = .7323). Delayed graft function risk factors such as donor age, terminal creatinine, and machine perfusion rate were similarly distributed across both groups. Conclusions: Normokalemic patients who did or did not undergo dialysis within 24 hours before transplant had equivalent incidence and duration of delayed graft function, graft outcomes, and patient outcomes. Therefore, dialysis within 24 hours before transplant is unnecessary in the setting of normokalemia.

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The dialysis procedure as a trigger for atrial fibrillation: new insights in the development of atrial fibrillation in dialysis patients

Cited by 102 publications

References 29 publications

Arrhythmia and Sudden Death in Hemodialysis Patients

Arrhythmia and Sudden Death in Hemodialysis Patients

Risk Factors of Ischemic Stroke and Subsequent Outcome in Patients Receiving Hemodialysis

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