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Intradialytic Hypotension and Cardiac Arrhythmias in Patients Undergoing Maintenance Hemodialysis: Results from the Monitoring in Dialysis Study

Patients receiving maintenance hemodialysis (HD) have a high incidence of cardiac events, including arrhythmia and sudden death. Intradialytic hypotension (IDH) is a common complication of HD and is associated with development of reduced myocardial perfusion, a potential risk factor for arrhythmia....

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Published in:Clinical journal of the American Society of Nephrology 2020-06, Vol.15 (6), p.805-812
Main Authors: Mc Causland, Finnian R, Tumlin, Jim A, Roy-Chaudhury, Prabir, Koplan, Bruce A, Costea, Alexandru I, Kher, Vijay, Williamson, Don, Pokhariyal, Saurabh, Charytan, David M
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container_title Clinical journal of the American Society of Nephrology
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creator Mc Causland, Finnian R
Tumlin, Jim A
Roy-Chaudhury, Prabir
Koplan, Bruce A
Costea, Alexandru I
Kher, Vijay
Williamson, Don
Pokhariyal, Saurabh
Charytan, David M
description Patients receiving maintenance hemodialysis (HD) have a high incidence of cardiac events, including arrhythmia and sudden death. Intradialytic hypotension (IDH) is a common complication of HD and is associated with development of reduced myocardial perfusion, a potential risk factor for arrhythmia. We analyzed data from the Monitoring in Dialysis study, which used implantable loop recorders to detect and continuously monitor electrocardiographic data from patients on maintenance HD ( =66 from the United States and India) over a 6-month period ( =4720 sessions). Negative binomial mixed effects regression was used to test the association of IDH (decline in systolic BP >20 mm Hg from predialysis systolic BP) and IDH (decline in systolic BP 0-20 mm Hg from predialysis systolic BP) with clinically significant arrhythmia (bradycardia≤40 bpm for ≥6 seconds, asystole≥3 seconds, ventricular tachycardia ≥130 bpm for ≥30 seconds, or patient-marked events) during HD. The median age of participants was 58 (25th-75th percentile, 49-66) years; 70% were male; and 65% were from the United States. IDH occurred in 2251 (48%) of the 4720 HD sessions analyzed, whereas IDH occurred during 1773 sessions (38%). The number of sessions complicated by least one intradialytic clinically significant arrhythmia was 27 (1.2%) where IDH occurred and 15 (0.8%) where IDH occurred. Participants who experienced IDH (versus not) had a nine-fold greater rate of developing an intradialytic clinically significant arrhythmia (incidence rate ratio, 9.4; 95% confidence interval, 3.0 to 29.4), whereas IDH was associated with a seven-fold higher rate (incidence rate ratio, 7.2; 95% confidence interval, 2.1 to 25.4). IDH is common in patients on maintenance HD and is associated with a greater risk of developing intradialytic clinically significant arrhythmia.
doi_str_mv 10.2215/CJN.06810619
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Intradialytic hypotension (IDH) is a common complication of HD and is associated with development of reduced myocardial perfusion, a potential risk factor for arrhythmia. We analyzed data from the Monitoring in Dialysis study, which used implantable loop recorders to detect and continuously monitor electrocardiographic data from patients on maintenance HD ( =66 from the United States and India) over a 6-month period ( =4720 sessions). Negative binomial mixed effects regression was used to test the association of IDH (decline in systolic BP &gt;20 mm Hg from predialysis systolic BP) and IDH (decline in systolic BP 0-20 mm Hg from predialysis systolic BP) with clinically significant arrhythmia (bradycardia≤40 bpm for ≥6 seconds, asystole≥3 seconds, ventricular tachycardia ≥130 bpm for ≥30 seconds, or patient-marked events) during HD. The median age of participants was 58 (25th-75th percentile, 49-66) years; 70% were male; and 65% were from the United States. IDH occurred in 2251 (48%) of the 4720 HD sessions analyzed, whereas IDH occurred during 1773 sessions (38%). The number of sessions complicated by least one intradialytic clinically significant arrhythmia was 27 (1.2%) where IDH occurred and 15 (0.8%) where IDH occurred. Participants who experienced IDH (versus not) had a nine-fold greater rate of developing an intradialytic clinically significant arrhythmia (incidence rate ratio, 9.4; 95% confidence interval, 3.0 to 29.4), whereas IDH was associated with a seven-fold higher rate (incidence rate ratio, 7.2; 95% confidence interval, 2.1 to 25.4). 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IDH occurred in 2251 (48%) of the 4720 HD sessions analyzed, whereas IDH occurred during 1773 sessions (38%). The number of sessions complicated by least one intradialytic clinically significant arrhythmia was 27 (1.2%) where IDH occurred and 15 (0.8%) where IDH occurred. Participants who experienced IDH (versus not) had a nine-fold greater rate of developing an intradialytic clinically significant arrhythmia (incidence rate ratio, 9.4; 95% confidence interval, 3.0 to 29.4), whereas IDH was associated with a seven-fold higher rate (incidence rate ratio, 7.2; 95% confidence interval, 2.1 to 25.4). IDH is common in patients on maintenance HD and is associated with a greater risk of developing intradialytic clinically significant arrhythmia.</abstract><cop>United States</cop><pub>American Society of Nephrology</pub><pmid>32381584</pmid><doi>10.2215/CJN.06810619</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-0299-0533</orcidid><oa>free_for_read</oa></addata></record>
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subjects Aged
Arrhythmias, Cardiac - epidemiology
Female
Humans
Hypotension - epidemiology
Hypotension - etiology
Hypotension - physiopathology
Incidence
India - epidemiology
Male
Middle Aged
Original
Prospective Studies
Renal Dialysis - adverse effects
Renal Dialysis - statistics & numerical data
Renal Insufficiency - therapy
United States - epidemiology
title Intradialytic Hypotension and Cardiac Arrhythmias in Patients Undergoing Maintenance Hemodialysis: Results from the Monitoring in Dialysis Study
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