Electrocardiographic findings in chronic hemodialysis patients

Bignotto, Luís Henrique; Kallás, Marina Esteves; Djouki, Rafael Jorge Teixeira; Sassaki, Marcela Mayume; Voss, Guilherme Ota; Soto, Cristina Lopez; Frattini, Fernando; Medeiros, Flávia Silva Reis

doi:10.5935/0101-2800.20120004

Cited by 23 publications

(34 citation statements)

References 20 publications

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“…402 Using the ICD re mote monitoring function, investigators demonstrated that AF was more frequent on hemodialysis days and increased during the hemodialysis procedure. 403 Abnor mal ECGs, including QTc prolongation, are common among patients on hemodialysis, 404 and QT prolonga tion has been identified as an independent predictor of mortality for patients on hemodialysis. 405 As described in a review of 5 studies, SCD has been noted in patients on hemodialysis, most commonly occurring during the 72hour time frame between dialysis treatments and within the first 12 hours after receiving a treatment.…”

Section: Hemodialysismentioning

confidence: 99%

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

198

214

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Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

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Section: Hemodialysismentioning

confidence: 99%

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

198

214

View full text Add to dashboard Cite

show abstract

“…1 The mechanisms of SCD in patients with CKD were diverse, but sinus bradycardia, atrioventricular (AV) block and ventricular tachyarrhythmia have been frequently observed. 2, 3 One of the possible pathophysiological changes associated with the CKD is abnormal activity of the sympathetic nervous system. 4, 5 Sympathetic hyperactivity is a cause of hypertension, which may contribute to the development of CKD.…”

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confidence: 99%

Subcutaneous nerve activity and mechanisms of sudden death in a rat model of chronic kidney disease

et al. 2016

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Background The mechanisms of sudden death in chronic kidney disease (CKD) remain unclear. Objective To test the hypotheses that subcutaneous nerve activity (SCNA) can be used to estimate sympathetic tone in ambulatory rats and that abrupt reduction of SCNA precedes the spontaneous arrhythmic death of Cy/+ rats. Methods Radiotransmitters were implanted in ambulatory normal (N=6) and Cy/+ (CKD; N=6) rats to record electrocardiogram and SCNA. Two additional rats were studied before and after chemical sympathectomy with 6-hydroxydopamine (6-OHDA). Results In normal rats, the baseline HR and SCNA were 351±29 bpm 5.12±2.97 mV-s, respectively; SCNA abruptly increased heart rate (HR) by 4.31% (95% confidence interval, CI, 4.15% to 4.47%). In comparison, the CKD rats had reduced baseline HR (336±21 bpm, p<0.01) and SCNA (4.27±3.19 mV-s, p<0.01). When SCNA was observed, the HR increased by only 2.48% (CI, 2.29% to 2.67%, p<0.01). All Cy/+ rats died suddenly, preceded by sinus bradycardia, advanced (2nd and 3rd degree) atrioventricular (AV) block (N=6) and/or ventricular tachycardia or fibrillation (N=3). Sudden death was preceded by a further reduction of SCNA (3.22±2.86 mV-s, p<0.01) and sinus bradycardia (243±55 bpm, p<0.01). Histological studies showed myocardial calcification in CKD rats that involved the conduction system. Chemical sympathectomy resulted in progressive reduction of SCNA over 7 days. Conclusions SCNA can be used to estimate sympathetic tone in ambulatory rats. CKD is associated with reduced HR response to SCNA and conduction system diseases. Abrupt reduction of sympathetic tone precedes AV block, ventricular arrhythmia and sudden death of the CKD rats.

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“…1 This interaction can predispose individuals to prolongation of the QTc interval, which represents an altered frequency of ventricular repolarization. 2 Ultimately, these electrophysiological changes can lead to fatal ventricular tachyarrhythmia and eventual hemodynamic collapse. 1 The risk factors for SCD include pre-existing coronary artery disease, heart failure, left ventricular hypertrophy, and diabetes mellitus.…”

mentioning

confidence: 99%

“…1 In a recent study, about 50% of patients undergoing dialysis had a prolonged QTc interval (> 440 ms). 2 Overall, cardiovascular disease is the primary cause of death in patients with end-stage renal disease, and SCD accounts for 60% of these cases. 2 The clinical dilemma of how to manage a patient who needs a drug that will potentially prolong the QTc interval often involves weighing the benefits and risks to the patient.…”

mentioning

confidence: 99%

“…2 Overall, cardiovascular disease is the primary cause of death in patients with end-stage renal disease, and SCD accounts for 60% of these cases. 2 The clinical dilemma of how to manage a patient who needs a drug that will potentially prolong the QTc interval often involves weighing the benefits and risks to the patient. One common example is that of domperidone for the treatment of gastroparesis.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Domperidone-Associated Sudden Cardiac Death in the General Population and Implications for Use in Patients Undergoing Hemodialysis: A Literature Review

Makari

Cameron

Battistella

2014

CJHP

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Electrocardiographic findings in chronic hemodialysis patients

Cited by 23 publications

References 20 publications

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Subcutaneous nerve activity and mechanisms of sudden death in a rat model of chronic kidney disease

Domperidone-Associated Sudden Cardiac Death in the General Population and Implications for Use in Patients Undergoing Hemodialysis: A Literature Review

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