Monitoring of arrhythmia and sudden death in a hemodialysis population: The CRASH-ILR Study

Roberts, Paul R.; Zachariah, Donah; Morgan, John M.; Yue, Arthur M.; Greenwood, Elizabeth; Phillips, Patrick C.; Kalra, Philip A.; Green, Darren; Lewis, Robert J.; Kalra, Paul R.

doi:10.1371/journal.pone.0188713

Cited by 42 publications

(43 citation statements)

References 28 publications

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“…Some studies have been conducted to assess preclinical arrhythmic burden in patients with ESKD requiring hemodialysis, using implantable cardiac monitors or loop recorders (6,7). In a study of 50 patients receiving hemodialysis, five deaths were classified as sudden cardiac death, which were due to bradycardia and asystole (8,9).…”

Section: Introductionmentioning

confidence: 99%

Rates of Cardiac Rhythm Abnormalities in Patients with CKD and Diabetes

Akoum¹,

Zelnick

Hirsch

et al. 2019

CJASN

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Background and objectivesCardiac arrhythmias increase mortality and morbidity in CKD. We evaluated the rates of subclinical arrhythmias in a population with type 2 diabetes and patients with moderate to severe CKD who were not on dialysis.Design, setting, participants & measurementsThis is a prospective observational study, using continuous ambulatory cardiac monitors to determine the rate of atrial and ventricular arrhythmias, as well as conduction abnormalities in this group.ResultsA total of 38 patients (34% women), with mean eGFR of 38±13 ml/min per 1.73 m2, underwent ambulatory cardiac monitoring for 11.2±3.9 days. The overall mean rate of any cardiac arrhythmia was 88.8 (95% confidence interval [95% CI], 27.1 to 184.6) episodes per person-year (PY). A history of cardiovascular disease was associated with a higher rate of detected arrhythmia (rate ratio, 5.87; 95% CI, 1.37 to 25.21; P<0.001). The most common arrhythmia was atrial fibrillation, which was observed in two participants with known atrial fibrillation and was a new diagnosis in four patients (11%), none of whom experienced symptoms. Overall, atrial fibrillation episodes occurred at a rate of 37.6 (95% CI, 2.4 to 112.3) per PY. Conduction abnormalities were found in eight patients (21%), a rate of 26.5 (95% CI, 4.2 to 65.5) per PY. Rates of ventricular arrhythmias were low (14.5 per PY; 95% CI, 4.3 to 32.0) and driven by premature ventricular contractions.ConclusionsCardiac rhythm abnormalities are common in patients with diabetes with moderate to severe CKD not requiring dialysis. Rates of atrial fibrillation are high and episodes are asymptomatic. Future studies are needed to determine the role of screening and upstream therapy of cardiac arrhythmias in this group.

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Section: Introductionmentioning

confidence: 99%

Rates of Cardiac Rhythm Abnormalities in Patients with CKD and Diabetes

Akoum¹,

Zelnick

Hirsch

et al. 2019

CJASN

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“…24 Our findings are consistent with recent prospective studies utilizing implantable loop monitors, which have also noted a marked predominance of nonventricular arrhythmias among patients on dialysis. 20,25,26 Although less than ten patients total in these prospective monitoring studies experienced sudden cardiac arrests, only one was due to ventricular arrhythmia, with the remainder related to bradyarrhythmias or asystole; among all clinically significant arrhythmias captured, bradycardia, asystole, and supraventricular tachycardia were observed far more frequently than ventricular tachycardias. The high rate of nonventricular arrhythmias may also explain decreased efficacies of implantable cardioverter defibrillators 27 and automated external defibrillators 7 that have been noted previously.…”

Section: Discussionmentioning

confidence: 96%

Outcomes for Hemodialysis Patients Given Cardiopulmonary Resuscitation for Cardiac Arrest at Outpatient Dialysis Clinics

Pun

Dupre

Starks

et al. 2019

JASN

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Background Out-of-hospital cardiac arrest, the leading cause of death among patients on hemodialysis, occurs frequently within outpatient dialysis centers. Practice guidelines recommend resuscitation training for all dialysis clinic staff and on-site defibrillator availability, but the extent of staff involvement in cardiopulmonary resuscitation (CPR) efforts and its association with outcomes is unknown. Methods We used data from the Cardiac Arrest Registry to Enhance Survival and the Centers for Medicare & Medicaid Services dialysis facility database to identify patients who had cardiac arrest within outpatient dialysis clinics between 2010 and 2016 in the southeastern United States. We compared outcomes of patients who received dialysis staff-initiated CPR with those who did not until the arrival of emergency medical services (EMS). Results Among 398 OHCA events in dialysis clinics, 66% of all patients presented with a nonshockable initial rhythm. Dialysis staff initiated CPR in 81.4% of events and applied defibrillators before EMS arrival in 52.3%. Staff were more likely to initiate CPR among men and witness cardiac arrests, and were more likely to provide CPR within larger dialysis clinics. Staff-initiated CPR was associated with a threefold increase in the odds of hospital discharge and favorable neurologic status on discharge. There was no overall association between staff-initiated defibrillator use and outcomes, but there was a nonsignificant trend toward improved survival to hospital discharge in the subgroup with shockable initial cardiac arrest rhythms. Conclusions Dialysis staff-initiated CPR was associated with a large increase in survival but was only performed in 81% of cardiac arrest events. Further investigations should focus on understanding the potential facilitators and barriers to CPR in the dialysis setting.

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“…There are a few studies assessing preclinical AF using implantable cardiac monitors or loop recorders in patients with ESRD requiring hemodialysis [8,11]. In a recent paper of 66 patients on dialysis, 41% had AF with temporal associations with timing of dialysis [12].…”

Section: Discussionmentioning

confidence: 99%

“…It can improve the poor cardiovascular outcomes in patients with CKD. There are a few studies assessing preclinical AF in patients with ESRD requiring hemodialysis [8,11,12], and in patients with CKD not receiving dialysis [13,14]. Recently, with the availability of noninvasive mobile cardiac monitors, there is an opportunity to characterize the incidence and burden of preclinical AF in large populations.…”

Section: Introductionmentioning

confidence: 99%

Chronic kidney disease and undiagnosed atrial fibrillation in individuals with diabetes

Heo

Rhee

Waalen

et al. 2020

Cardiovasc Diabetol

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Background Diabetes is an independent risk factor for atrial fibrillation (AF), which is associated with increases in mortality and morbidity, as well as a diminished quality of life. Renal involvement in diabetes is common, and since chronic kidney disease (CKD) shares several of the same putative mechanisms as AF, it may contribute to its increased risk in individuals with diabetes. The objective of this study is to identify the relationship between CKD and the rates of newly-diagnosed AF in individuals with diabetes taking part in a screening program using a self-applied wearable electrocardiogram (ECG) patch. Materials and methods The study included 608 individuals with a diagnosis of diabetes among 1738 total actively monitored participants in the prospective mHealth Screening to Prevent Strokes (mSToPS) trial. Participants, without a prior diagnosis of AF, wore an ECG patch for 2 weeks, twice, over a 4-months period and followed clinically through claims data for 1 year. Definitions of CKD included ICD-9 or ICD-10 chronic renal failure diagnostic codes, and the Health Profile Database algorithm. Individuals requiring dialysis were excluded from trial enrollment. Results Ninety-six (15.8%) of study participants with diabetes also had a diagnosis of CKD. Over 12 months of follow-up, 19 new cases of AF were detected among the 608 participants. AF was newly diagnosed in 7.3% of participants with CKD and 2.3% in those without (P < 0.05) over 12 months of follow-up. In a univariate Cox proportional hazard regression analysis, the risk of incident AF was 3 times higher in individuals with CKD relative to those without CKD: hazard ratios (HR) 3.106 (95% CI 1.2–7.9). After adjusting for the effect of age, sex, and hypertension, the risk of incident AF was still significantly higher in those with CKD: HR 2.886 (95% CI 1.1–7.5). Conclusion Among individuals with diabetes, CKD significantly increases the risk of incident AF. Identification of AF prior to clinical symptoms through active ECG screening could help to improve the clinical outcomes in individuals with CKD and diabetes.

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Monitoring of arrhythmia and sudden death in a hemodialysis population: The CRASH-ILR Study

Cited by 42 publications

References 28 publications

Rates of Cardiac Rhythm Abnormalities in Patients with CKD and Diabetes

Rates of Cardiac Rhythm Abnormalities in Patients with CKD and Diabetes

Outcomes for Hemodialysis Patients Given Cardiopulmonary Resuscitation for Cardiac Arrest at Outpatient Dialysis Clinics

Chronic kidney disease and undiagnosed atrial fibrillation in individuals with diabetes

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