IntroductionIt has been suggested that sudden cardiac death (SCD) contributes around 50% of cardiovascular and 27% of all-cause mortality in hemodialysis patients. The true burden of arrhythmias and arrhythmic deaths in this population, however, remains poorly characterised. Cardio Renal Arrhythmia Study in Hemodialysis (CRASH-ILR) is a prospective, implantable loop recorder single centre study of 30 established hemodialysis patients and one of the first to provide long-term ambulatory ECG monitoring.Methods30 patients (60% male) aged 68±12 years receiving hemodialysis for 45±40 months with varied etiology (diabetes 37%, hypertension 23%) and left ventricular ejection fraction (LVEF) 55±8% received a Reveal XT implantable loop recorder (Medtronic, USA) between August 2011 and October 2014. ECG data from loop recorders were transmitted at each hemodialysis session using a remote monitoring system. Primary outcome was SCD or implantation of a (tachy or bradyarrhythmia controlling) device and secondary outcome, the development of arrhythmia necessitating medical intervention.ResultsDuring 379,512 hours of continuous ECG monitoring (mean 12,648±9,024 hours/patient), there were 8 deaths—2 SCD and 6 due to generalised deterioration/sepsis. 5 (20%) patients had a primary outcome event (2 SCD, 3 pacemaker implantations for bradyarrhythmia). 10 (33%) patients reached an arrhythmic primary or secondary end point. Median event free survival for any arrhythmia was 2.6 years (95% confidence intervals 1.6–3.6 years).ConclusionsThe findings confirm the high mortality rate seen in hemodialysis populations and contrary to initial expectations, bradyarrhythmias emerged as a common and potentially significant arrhythmic event.

Early in the coronavirus-2019 (COVID-19) containment strategy, people with end-stage renal disease (ESRD) were identified as extremely clinically vulnerable and subsequently asked to ‘shield’ at home where possible. The aim of this study was to investigate how these restrictions and the transition to an increased reliance on telemedicine within clinical care of people living with kidney disease impacted the physical activity (PA), wellbeing and quality of life (QoL) of adults dialysing at home (HHD) or receiving in-centre haemodialysis (ICHD) in the UK. Individual semistructured telephone interviews were conducted with adults receiving HHD (n = 10) or ICHD (n = 10), were transcribed verbatim and, subsequently, thematically analysed. As result of the COVID-19 restrictions, PA, wellbeing and QoL of people with ESRD were found to have been hindered. However, widespread support for the continued use of telemedicine was strongly advocated and promoted independence and satisfaction in patient care. These findings highlight the need for more proactive care of people with ESRD if asked to shield again, as well as increased awareness of safe and appropriate PA resources to help with home-based PA and emotional wellbeing.

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Background When people with chronic kidney disease reach kidney failure, renal replacement therapy is usually required to improve symptoms and maintain life. Although in‐centre haemodialysis is most commonly used for this purpose, other forms of dialysis are available, including home haemodialysis and peritoneal dialysis. Objectives We aimed to explore the experiences of adults living with chronic kidney disease who were either approaching the need for dialysis or had reached kidney failure and were receiving a form of dialysis. In particular, we explored how different forms of dialysis affect their quality of life, wellbeing, and physical activity. Methods Individual semistructured interviews were conducted with 40 adults with kidney failure, comprising four groups (n = 10 each): those receiving in‐centre haemodialysis, home haemodialysis or peritoneal dialysis, or predialysis. Interviews were transcribed verbatim, thematically analysed, and then composite vignettes were subsequently developed to present a rich narrative of the collective experiences of each group. Findings Compared with adults who were predialysis, quality of life and wellbeing improved upon initiation of their home haemodialysis or peritoneal dialysis. Conversely, minimal improvement was perceived by those receiving in‐centre haemodialysis. Low physical activity was reported across all four groups, although those receiving home haemodialysis and peritoneal dialysis reported a greater desire and ability to be physically active than those in‐centre. Conclusion These findings highlight that dialysis modalities not requiring regular hospital attendance (i.e., home haemodialysis and peritoneal dialysis) improve independence, quality of life, wellbeing, and can facilitate a more physically active lifestyle.

Background Treatment of end-stage renal disease (ESRD) is necessary to maintain life. However, it can cause physiological, psychosocial, and cognitive impairments, which may impact physical activity (PA) and sleep, although there is insufficient device-based data to elucidate such impacts. Methods PA, sedentary time (SED), and sleep were measured over 7 consecutive days in 12 adults with ESRD (9 dialyzing at home, 3 dialyzing in center) using wrist-worn accelerometers. Validated raw acceleration thresholds were used to quantify time spent in each PA intensity domain and SED, and sleep duration and efficiency. Results Adults with ESRD engaged in little moderate-to-vigorous PA (MVPA; 6.9 ± 9.7 min·d−1) and spent 770.0 ± 68.6 min·d−1 SED. People dialyzing at home engaged in more light-intensity PA than those attending in center (131.2 ± 28.1 versus 106.9 ± 5.4 min·d−1, respectively; P = 0.05); however, neither group met the recommended guidelines for daily MVPA. Individuals with ESRD slept for an average of 286.8 ± 79.3 min·night−1 with an efficiency of 68.4 ± 18.5%, although people dialyzing at home slept for longer and more efficiently (74.5% versus 50.0%, P = 0.07) than those attending in center. Conclusion In this study, we suggest that adults with ESRD engage in less total PA than recommended guidelines and are characterized by poor sleep duration and efficiency. Moreover, results indicate that dialysis mode may influence PA, SED, and sleep, with those dialyzing at home engaging in greater leisure time PA and achieving a greater sleep duration and efficiency.