Arrhythmias in Chronic Kidney Disease

Akhtar, Zaki; Leung, Lisa; Kontogiannis, Christos; Chung, Isaac; Waleed, Khalid Bin; Gallagher, Mark M.

doi:10.15420/ecr.2021.52

Cited by 15 publications

(13 citation statements)

References 97 publications

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“…Patients with CKD are vulnerable to cardiac arrhythmia and in many cases, renal dysfunction stimulates arrhythmia and arrhythmia exacerbates renal dysfunction [ 2 ]. In a recent study, the ARIC study, a 2-week cardiac monitoring of patients with CKD revealed a high prevalence of non-sustained ventricular tachycardia (30.2%) and AF (7.4%), while ventricular ectopy was present in more than 90% of patients [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study, the ARIC study, a 2-week cardiac monitoring of patients with CKD revealed a high prevalence of non-sustained ventricular tachycardia (30.2%) and AF (7.4%), while ventricular ectopy was present in more than 90% of patients [ 13 ]. The mechanism of arrhythmia in CKD may be due to electrolyte disturbances and/or the damage caused to kidneys and heart tissues by common comorbidities like hypertension and diabetes mellitus [ 2 ]. Arrhythmia causes premature death in the general population as well as in patients with CKD [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…The mechanism of arrhythmia in CKD may be due to electrolyte disturbances and/or the damage caused to kidneys and heart tissues by common comorbidities like hypertension and diabetes mellitus [ 2 ]. Arrhythmia causes premature death in the general population as well as in patients with CKD [ 2 ]. Sudden Cardiac Death (SCD) is common in CKD patients and it is the most common cause of death in dialysis patients [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Because most arrhythmias are intermittent and usually asymptomatic, documentation and diagnosis pose a challenge to the treating physician [ 2 ]. Several electrocardiographic (ECG) methods can be used to assess the risk of arrhythmia and this includes measurement of the P-WD, QTc interval, Tp-e interval, and QTc dispersion on the standard resting 12-lead ECG.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiovascular disease (CVD) is the commonest cause of death in CKD as it accounts for 43% of all-cause mortality in hemodialysis patients [ 1 ]. Arrhythmia is common in patients with CKD and sudden cardiac death accounts for 25% of deaths in dialysis patients [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Electrocardiographic substrates of arrhythmias in patients with end-stage and chronic kidney diseases: a case–control study

et al. 2023

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Background Cardiovascular disease (CVD) is the most common cause of death in patients with renal diseases. Cardiac arrhythmia and sudden cardiac death are particularly important, and the burden is higher in patients on hemodialysis. The aim of this study is to compare specific ECG changes as markers of arrhythmias in patients with CKD and patients with end-stage renal disease (ESRD); all without clinically manifest heart disease, with normal control subjects. Results Seventy-five ESRD patients on regular hemodialysis, 75 patients with stage 3–5 CKD and 40 healthy control subjects were included. All candidates were subjected to thorough clinical evaluation and laboratory tests including serum creatinine, glomerular filtration rate calculation, serum potassium, magnesium, calcium, phosphorus, iron, parathyroid hormone, and total iron binding capacity (TIBC). Resting twelve-lead ECG was done to calculate P wave dispersion (P-WD), corrected QT interval, QTc dispersion, Tpeak-Tend interval (Tp-e), and Tp-e/QT. Patients with ESRD had a significantly higher QTc dispersion (p < 0.001) and P-WD (p = 0.001) when compared to the other 2 groups. In the ESRD group, males had a significantly higher P-WD (p = 0.045), insignificantly higher QTc dispersion (p = 0.445), and insignificantly lower Tp-e/QT ratio (p = 0.252) as compared to females. Multivariate linear regression analysis for ESRD patients showed that serum creatinine (β = 0.279, p = 0.012) and transferrin saturation (β = − 0.333, p = 0.003) were independent predictors of increased QTc dispersion while ejection fraction (β = 0.320, p = 0.002), hypertension (β = − 0.319, p = 0.002), hemoglobin level (β = − 0.345, p = 0.001), male gender (β = − 0.274, p = 0.009) and TIBC (β = − 0.220, p = 0.030) were independent predictors of increased P wave dispersion. In the CKD group, TIBC (β = − 0.285, p = 0.013) was an independent predictor of QTc dispersion while serum calcium (β = 0.320, p = 0.002) and male gender (β = − 0.274, p = 0.009) were independent predictors of Tp-e/QT ratio. Conclusions Patients with stage 3–5 CKD and those with ESRD on regular hemodialysis exhibit significant ECG changes that are considered substrates for ventricular as well as supraventricular arrhythmias. Those changes were more evident in patients on hemodialysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Electrocardiographic substrates of arrhythmias in patients with end-stage and chronic kidney diseases: a case–control study

et al. 2023

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Microwave‐assisted Synthesis of Poly(methacrylic acid) Particles for Blood Purification

Alimohammadi,

Upadhyay,

Gillespie

et al. 2024

Adv Materials Inter

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A new method is introduced for the rapid synthesis of poly(methacrylic acid) (PMAA) macroparticles via microwave irradiation, optimizing the ratio of monomer to crosslinker to finely tailor the particles’ characteristics. In the study, the characteristics of these particles have been analyzed extensively, and their potential efficacy in blood purification applications has been explored. They are demonstrating significant potential for cation removal from dialysate and blood. The PMAA particles with the lower crosslinker concentration exhibited superior cation removal efficiency, achieving 80.8% for calcium, 9.9% for potassium, and 9.9% for sodium ions from dialysate solution over a period of 4 h. Blood compatibility assessments, encompassing protein adsorption and clotting time, showed the particles' hemocompatibility. The exceptional physical and mechanical attributes of the PMAA particles are positioned as promising candidates for use as absorbents in dialysis and hemoperfusion processes. Furthermore, their versatility extends beyond blood purification, marking their relevance in broader applications such as water treatment.

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Physical frailty, genetic predisposition, and incident arrhythmias

Zhang,

Liu,

et al. 2024

J cachexia sarcopenia muscle

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BackgroundCross‐sectional evidence suggests a possible link between frailty and atrial fibrillation (AF). It remains unclear whether frailty and incident arrhythmias are longitudinally associated. This study aimed to determine whether the frailty phenotype is longitudinally associated with incident arrhythmias, especially AF.MethodsIn this prospective cohort of UK Biobank, individuals with arrhythmias at baseline, those without data for frailty phenotype, and no genetic data were excluded. Five domains of physical frailty, including weight loss, exhaustion, low physical activity, low grip strength, and slow gait speed, were assessed. A total of 142 single‐nucleotide polymorphisms was used to calculate the polygenic risk score (PRS) for AF. Hospital inpatient records and death records were used to identify incident arrhythmias.ResultsThis study included 464 154 middle‐aged and older adults (mean age 56.4 ± 8.1 years, 54.7% female) without arrhythmia at baseline. During a median follow‐up of 13.4 years (over 5.9 million person‐years), 46 454 new‐onset arrhythmias cases were recorded. In comparison with non‐frailty, the multivariable‐adjusted hazard ratios (HRs) of AF were 1.12 (95% CI: 1.09, 1.15, P < 0.0001) and 1.44 (95% CI: 1.36, 1.51, P < 0.0001) for participants with pre‐frailty and frailty, respectively. Similar associations were observed for other arrhythmias. We found that slow gait speed presented the strongest risk factor in predicting all arrhythmias, including AF (HR 1.34, 95% CI: 1.30, 1.39), bradyarrhythmias (HR 1.30, 95% CI: 1.22, 1.37), conduction system diseases (HR 1.29, 95% CI: 1.22, 1.36), supraventricular arrhythmias (HR 1.32, 95% CI: 1.19, 1.47), and ventricular arrhythmias (HR 1.37, 95% CI: 1.25, 1.51), with all P values <0.0001. In addition to slow gait speed, weight loss (HR 1.13, 95% CI: 1.09, 1.16, P < 0.0001) and exhaustion (HR 1.11, 95% CI: 1.07, 1.14, P < 0.0001) were significantly associated with incident AF, whereas insignificant associations were observed for physical activity (HR 1.03, 95% CI: 0.996, 1.08, P = 0.099) and low grip strength (HR 1.00, 95% CI: 0.97, 1.03, P = 0.89). We observed a significant interaction between genetic predisposition and frailty on incident AF (P for interaction <0.0001), where those with frailty and the highest tertile of PRS had the highest risk of AF (HR 3.34, 95% CI: 3.08, 3.61, P < 0.0001) compared with those with non‐frailty and the lowest tertile of PRS.ConclusionsPhysical pre‐frailty and frailty were significantly and independently associated with incident arrhythmias. Although direct causal inference still needs to be further validated, these results suggested the importance of assessing and managing frailty for arrhythmia prevention.

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Arrhythmias in Chronic Kidney Disease

Cited by 15 publications

References 97 publications

Electrocardiographic substrates of arrhythmias in patients with end-stage and chronic kidney diseases: a case–control study

Electrocardiographic substrates of arrhythmias in patients with end-stage and chronic kidney diseases: a case–control study

Microwave‐assisted Synthesis of Poly(methacrylic acid) Particles for Blood Purification

Physical frailty, genetic predisposition, and incident arrhythmias

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