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2014, Number 4

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Revista Habanera de Ciencias Médicas 2014; 13 (4)

Ventricular arrhythmias in patients with end-stage chronic renal disease on haemodialysis. Intradialytic Holter monitoring

Suárez CAM, Otero MJM, Méndez RA, Cruillas MS, Ayala GHR, Argudín SR, Otero SM

Language: Spanish
References: 22
Page: 516-530
PDF size: 153.78 Kb.


ABSTRACT

Introduction: cardiac arrhythmias are frequent in dialysis patients and may contribute to mortality.
Objectives: to estimate the frequency of significant intradialytic ventricular arrhythmias potentially life-threatening in patients with end-stage of chronic renal disease taking hemodialysis (HD) and its association with ventricular arrhythmias and clinical, laboratory, and electrocardiogram and echocardiogram parameters.
Material and Methods: 34 patients with end-stage renal disease on maintenance hemodialysis in three hospitals of Havana were studied. Body weight and blood pressure were recorded before and after HD. Pre dialysis and post dialysis blood samples were taken for estimation of potassium, calcium and urea. Electrocardiogram and echocardiogram were also applied. Holter monitoring was performed the first and second days of dialysis during all HD session. 68 recordings were analyzed. Ventricular arrhythmias were stratified according to the Lown´s classification. Classes 3 and above were taken as complex ventricular arrhythmias.
Results: ventricular arrhythmias during HD were noted in 36 recordings (53%) and 32 recordings did not have any ventricular arrhythmias during HD. In 22 recordings (32%) ventricular arrhythmias were potentially life-threatening. Age › 45, mean blood pressure post dialysis › 105 mmHg, and ST-segment depression › 2mm were statistically significant. Left ventricular hypertrophy, duration of HD › 5 years, atria arrhythmias and mean blood pressure pre dialysis › 105 mmHg were associated with complex ventricular arrhythmias but they did not show statistical significant.
Conclusions: ventricular arrhythmias were detected in a significant proportion of patients with end-stage renal disease during hemodialysis. Complex ventricular arrhythmias or potentially life-threatening arrhythmias were seen in most of the recordings performed.


REFERENCES

  1. Kanbay M, Afsar B, Goldsmith D, Covic A. Sudden Death in Hemodialysis. An Update. Blood Purif. 2010; 30: 135-145. [Citado Mayo 10]. Disponible en: http://www.karger.com/Article/FullText/320370

  2. Bozbas H, Atar I, Yildirir, Ozgul A. Clinical Study. Prevalence and Predictors of Arrhythmia in End Stage Renal Disease Patients on Hemodialysis. Turkey Renal Failure 2007; 29:331_339. [Citado 2013, Mayo 10]. Disponible en: http://informahealthcare.com/doi/abs/10.1080/08860220701191237

  3. Quiroga B, Villaverde M, Abad S, Vega A, Reque J, López-Gómez JM. Diastolic Dysfunction and High Levels of New Cardiac Biomarkers as Risk Factors for Cardiovascular Events and Mortality in Hemodialysis Patients. Blood Purif. 2013 Sep 14;36(2): 98-106. [Citado 2013, Octubre 15]. Disponible en: http://www.karger.com/Article/FullText/354080

  4. Covic AC, Buimistriuc LD, Green D, Stefan A, Badarau S, Kalra PA. The prognostic value of electrocardiographic estimation of left ventricular hypertrophy in dialysis patients. Ann Noninvasive Electrocardiol. 2013 ;18(2):188-98.

  5. Shastri S, Tangri N, Tighiouart H, Beck GJ, Vlagopoulos Pet al. Predictors of sudden cardiac death: a competing risk approach in the hemodialysis study. Clin J Am Soc Nephrol. 2012 Jan; 7(1):123-30. [Citado 2013, Mayo 10]. Disponible en: http://cjasn.asnjournals.org/content/7/1/123.long

  6. Pun PH, Middleton JP. Sudden cardiac death in hemodialysis patients. A comprehensive care approach to reduce risk. Blood Purif. 2012; 33 (1-3):183-9. [Citado 2013, Mayo 10]. Disponible en: http://www.karger.com/Article/FullText/334154

  7. Bleyer AJ, Hartman J, Brannon PC, Reeves-Daniel A, Satko SG, Russell G. Characteristics of sudden death in hemodialysis patients. Kidney Int 2006; 69:2268_2273. [Citado 2013, Abril 20]. Disponible en: http://www.nature.com/ki/journal/v69/n12/full/5000446a.html

  8. Selby NM, Mcintyre CW. The Acute Cardiac Effects of Dialysis. Seminars in Dialysis 2007; 20: 220_228. [Citado 2013, Febrero 6]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/j.1525-139X.2007.00281.x/abstract

  9. Middleton JP. Predisposition to Arrhythmias: Electrolytes, Uremic Fibrosis, Other Factors Carolina Seminars in Dialysis 2011; 24 (3): 287-289. [Citado 2013, Mayo 10]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/j.1525 - 139X.2011.00866.x/abstract

  10. Genovesi S, Rossi E, Nava M, Riva H, De Franceschi S, Fabbrini P, et al. A case series of chronic haemodialysis patients: mortality, sudden death, and QT interval. Europace. 2013 Jul; 15(7):1025-33. [Citado 2013, Septiembre 15]. Disponible en: http://europace.oxfordjournals.org/content/15/7/1025.long

  11. Lown B, Wolf M. Approaches to sudden death from coronary heart disease. Circulation 1974; 44:130_142. [Citado 2013, Mayo 10]. Disponible en: http://circ.ahajournals.org/content/44/1/130.long

  12. Bazzet HC. An analysis of the time-relations of electrocardiograms. Heart. 1920; 7:353-70.

  13. Herzog CA, Mangrum JM, Passman R. Sudden cardiac death and dialysis patients. Semin Dial 2008; 21: 300_307. [Citado 2013, Mayo 10]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/j.1525-139X.2008.00455.x/abstract

  14. Holme I, Fellström BC, Jardin AG, Schmieder RE, Zannad F, Holdaas H. Prognostic model for total mortality in patients with haemodialysis from the Assessments of Survival and Cardiovascular Events (AURORA) study.J Intern Med. 2012 May; 271(5):463-71. [Citado 2013, Mayo 10]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/j.1365- 2796.2011.02435.x/abstract;jsessionid=22E091471F28445350657B1A8EA4410E.f0 4t02

  15. De Bie MK, Buiten MS, Rabelink TJ, Jukema JW. How to reduce sudden cardiac death in patients with renal failure. Heart. 2012; 98:335-341. [Citado 2013, Mayo 10]. Disponible en: http://heart.bmj.com/content/98/4/335.long

  16. Shamseddin MK & Parfrey PS. Sudden cardiac death in chronic kidney disease: epidemiology and prevention. Nat. Rev. Nephro 2011; 7: 145_154. [Citado 2013, Agosto 14]. Disponible en: http://www.nature.com/nrneph/journal/v7/n3/full/nrneph.2010.191.html

  17. Burton JO, Korsheed S, Grundy BJ, McIntyreCW. Hemodialysis-induced left ventricular dysfunction is associated with an increase in ventricular arrhythmias. Ren Fail 2008; 30(7):701-709.

  18. Green D, Roberts PR. Sudden Cardiac Death in Hemodialysis Patients. An In- Depth Review Am J Kidney Dis. 2011; 57(6):921-929. [Citado 2013, Julio 11]. Disponible en: http://www.ajkd.org/article/S0272-6386%2811%2900595-6/fulltext

  19. Valentim B, Pereira A, Coelho P, Pereira T. Study of ventricular electrical systole in patients with end-stage kidney disease on hemodialysis. Arq Bras Cardiol. 2013 Mar; 100(3):261-8. [Citado 2013. Septiembre 12]. Disponible en: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066- 782X2013000300008&lng=en&nrm=iso&tlng=pt

  20. Daya SK, Gowda RM, Khan IA. Ciprofloxacin- and hypocalcemia-induced torsade de pointes triggered by hemodialysis. Am J Ther. 2004;11(1):77-9.

  21. Letavernier E, Couzi L, Delmas Y, Moreau K, Murcott O, De Précigout V. Verapamil and mild hyperkalemia in hemodialysis patients: a potentially hazardous association. Hemodial Int. 2006;10(2):170-2.

  22. McIntyre CW. Effects of hemodialysis on cardiac function. Kidney International. 2009; 76: 371-375. [Citado 2013, Junio 15]. Disponible en: http://www.nature.com/ki/journal/v76/n4/full/ki2009207a.html




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