Language
English
Publication Date
12-1-2022
Journal
Kidney360
DOI
10.34067/KID.0003142022
PMID
36514397
PMCID
PMC9717630
PubMedCentral® Posted Date
10-11-2022
PubMedCentral® Full Text Version
Post-print
Abstract
Background: Bradycardia and asystole events are common among patients treated with maintenance hemodialysis. However, triggers of these events in patients on maintenance hemodialysis (HD), particularly during the long interdialytic period when these events cluster, are uncertain.
Methods: The Monitoring in Dialysis Study (MiD) enrolled 66 patients on maintenance HD who were implanted with loop recorders and followed for 6 months. We analyzed associations of predialysis laboratory values with clinically significant bradyarrhythmia or asystole (CSBA) during the 12 hours before an HD session. Associations with CSBA were analyzed with mixed-effect models. Adjusted negative binomial mixed-effect regression was used to estimate incidence rate ratios (IRR) for CSBA. We additionally evaluated associations of CSBA at any time during follow-up with time-averaged dialytic and laboratory parameters and associations of peridialytic parameters with occurrence of CSBA from the start of one HD session to the beginning of the next.
Results: There were 551 CSBA that occurred in the last 12 hours of the interdialytic interval preceding 100 HD sessions in 12% of patients and 1475 CSBA events in 23% of patients overall. We did not identify significant associations between dialytic parameters or serum electrolytes and CSBA in the last 12 hours of the interdialytic interval in adjusted analyses. Median time-averaged ultrafiltration rate was significantly higher in individuals without CSBA (9.8 versus 8, P=0.04). Use of dialysate sodium concentrations ≤135 (versus 140) mEq/L was associated with a reduced risk of CSBA from the start of one session to the beginning of next.
Conclusions: Although a few factors had modest associations with CSBA in some analyses, we did not identify any robust associations of modifiable parameters with CSBA in the MiD Study. Further investigation is needed to understand the high rates of arrhythmia in the hemodialysis population.
Keywords
arrhythmia, asystole, bradycardia, dialysis
Published Open-Access
yes
Recommended Citation
Ziolkowski, Susan; Liu, Sai; Montez-Rath, Maria E; et al., "Association Between Cause of Kidney Failure and Fracture Incidence in a National Us Dialysis Population Cohort Study" (2022). Faculty and Staff Publications. 4105.
https://digitalcommons.library.tmc.edu/baylor_docs/4105
Graphical Abstract
Comments
Trial registration: ClinicalTrials.gov NCT01779856.