Silent Myocardial Ischemia and High-Grade Ventricular Arrhythmias in Patients on Maintenance Hemodialysis

Mohiuddin, Khalid; Bali, Harinder K.; Banerjee, Saurav; Sakhuja, Vinay; Jha, Vivekanand

doi:10.1081/jdi-48236

Cited by 32 publications

(19 citation statements)

References 19 publications

(8 reference statements)

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“…Repeated episodes of stunning are cumulative and contribute to the pathophysiology of heart failure (4). We and other investigators have previously shown evidence that subclinical ischemia occurs in response to the stress of hemodialysis (5)(6)(7). We also demonstrated that it was possible to reduce the frequency and the severity of this phenomenon by using biofeedback dialysis (Hemocontrol, Gambro-Hospal, Mirandora, Italy) to improve the hemodynamic tolerability of dialysis.…”

mentioning

confidence: 78%

“…The echocardiographic findings of dialysisinduced LV RWMA that were seen in both our previous study and in these results are strongly suggestive of subclinical ischemia, analogous to dobutamine stress echocardiography (16). In addition to the work from our center, one study demonstrated dialysis-induced perfusion defects using single photon emission computed tomography (7), and there are 10 reports of silent intradialytic ST depression detected by Holter monitoring (6,(17)(18)(19)(20)(21)(22)(23)(24)(25). Although initially there was concern that some electrocardiographic changes that were observed during dialysis were related to changes in electrolyte concentrations as opposed to myocardial hypoperfusion, the demonstration of dialysis-induced ischemia by electrocardiographic, echocardiographic, and isotopic techniques certainly suggests that such findings are attributable to ischemia.…”

Section: Discussionmentioning

confidence: 99%

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Dialysis-Induced Regional Left Ventricular Dysfunction Is Ameliorated by Cooling the Dialysate

Selby

Burton

Chesterton

et al. 2006

Clinical Journal of the American Society of Nephrology

155

166

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Dialysis patients who develop cardiac failure have a poor prognosis. Recurrent subclinical myocardial ischemia is important in the genesis of heart failure in nondialysis patients. It has previously been demonstrated that subclinical ischemia occurs during hemodialysis; therefore, this study examined whether the improved stability of cool-temperature dialysis lessens this phenomenon. Ten patients who were prone to intradialytic hypotension entered a randomized, crossover study to compare the development of dialysis-induced left ventricular (LV) regional wall motion abnormalities (RWMA) at dialysate temperatures of 37 and 35°C. Serial echocardiography with quantitative analysis was used to assess ejection fraction and regional systolic LV function. BP and hemodynamic variables were measured using continuous pulse wave analysis. The severity of thermal symptoms was scored using a simple questionnaire. Forty-nine new RWMA developed in nine patients during hemodialysis with dialysate at 37°C (HD 37 ), compared with thirteen RWMA that developed in four patients during HD 35 (odds ratio 3.8; 95% confidence interval 2.1 to 6.9). The majority of RWMA displayed improved function by 30 min after dialysis. Overall, regional systolic LV function was significantly more impaired during HD 37 (P < 0.001). BP was higher during HD 35 , with fewer episodes of hypotension as a result of a higher peripheral resistance and no difference in stroke volume. The development of thermal symptoms was heterogeneous, with most patients tolerating HD 35 well. This study confirms previous findings of reversible LV RWMA that develop during hemodialysis. It also shows that this phenomenon can be ameliorated by reducing dialysate temperature, a simple intervention with no cost implications.

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mentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Dialysis-Induced Regional Left Ventricular Dysfunction Is Ameliorated by Cooling the Dialysate

Selby

Burton

Chesterton

et al. 2006

Clinical Journal of the American Society of Nephrology

155

166

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“…In a study of Hamidreza Nasri et al mean age was 47.9 16.1 year 9 . In other studies the mean age of patients had been reported from 38.2 year in 1997 to 52.5 in 2007 10,18,19 . It seems better control and management of disease leading to dialysis leads to later presentation of renal complications.…”

Section: Discussionmentioning

confidence: 99%

“…In a study Holter monitoring showed silent MI in 22% cases during dialysis 19 . A significant increase happened in the frequency of ventricular arrhythmias during and after dialysis.…”

Section: Conflict Of Interestmentioning

confidence: 99%

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Patterns of Cardiac Arrhythmia in Haemodialysis Patients

Mahmood

Haq

Giasuddin

et al. 2017

Anwer Khan Mod Med Coll J

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Background: Cardiovascular disorders are one of the most serious problems in chronic haemodialysis patients. According to the records of last 15 years, 50% of these patients died from cardiovascular complications every year, without a marked reduction in the annual frequency of deaths. Cardiac arrhythmias are frequently associated with haemodialysis and have been reported to be seen in some series in up to 76% of patients.Materials & Methods: They appear to occur mostly after the first 3 hours of dialysis. In this study we have evaluated the arrhythmias that occured before and during dialysis to reduce the burden of morbidity and mortality of the patients. This is a cross sectional descriptive type of observational study on haemodialysis patients in Medical College for Women and Hospital (MCWH). Duration of study was 2 years, from July 2011 to June 2013.All the patients of end stage renal disease (ESRD) on maintenance haemodialysis (MHD) were included in the study. 81 patients were included to the study. One patient had permanent pacemaker and was excluded. Four patients had died during the study and four patients did not co-operated and left the study. Holter monitoring of a patient was unreadable because of artifact. Finally 71 patients were studied.Results: Out of 71 patients 38 were males and 33 were females with male to female ratio of 1.5:1. The mean age of the patient was 50.81 12.45 ( Range-22-75 ) year. Among 71 patients 19 had both DM and HTN and 42 patients had only HTN and 10 patients had other causes of chronic kidney disease (CKD).Premature atrial contraction(PAC) 27(40.30%) and Premature ventricular contraction(PVC) 40(59.70%)were the most common arrhythmia in dialysis patients before and during dialysis in our study. We found no significant effect of heamodialysis (HD) on cardiac arrhythmia. There was no correlation between arrhythmia and changes in Hb%, HbA1C, S. Albumin, S Creatinine, ions changes(Na+, K+, Ca++, Mg++)before and during haemodialysis (HD). QT intervals had no significant increase in dialysis patients. The prevalence of Atrial fibrillation (AF) rhythm was 5.63%.A high prevalence of cardiovascular disease is observed in end stage renal disease(ESRD) patients receiving dialysis therapy.Conclusion: The number of arrhythmias did not increase during dialysis in patients with no history of cardiac diseases, so the dialysis itself is not a leading risk factor for arrhythmias. But if a patient has history of arrhythmia, ischemia or left ventricular hypertrophy(LVH), he should be monitored during haemodialysis or undergo peritoneal dialysis in order to reduce the arrhythmia risk.Anwer Khan Modern Medical College Journal Vol. 7, No. 1: Jan 2016, P 28-33

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Prevention of Sudden Cardiac Death in Dialysis Patients: A Nephrologist's Perspective

Bleyer

2008

Dialysis & Transplantation

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Sudden cardiac death is responsible for approximately 25% of all deaths in the dialysis population. 1 At a representative U.S. dialysis center with 100 patients, there will be approximately 20 deaths per year, and 5 of these will be from sudden death. 2 Prevention of sudden death would therefore be extremely benefi cial in decreasing the overall mortality of each dialysis center. Yet nephrologists spend a disproportionate amount of time fi ddling with Kt/V while deaths occur from cardiac causes. A recent PubMed citation search with the key words sudden death and hemodialysis revealed only 150 articles, as compared with 1,400 articles with the key words Kt/V and hemodialysis. The purpose of this article is to motivate nephrologists to attack the problem of sudden death of their patients and to help them in the development of a system to prevent these events.

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Silent Myocardial Ischemia and High-Grade Ventricular Arrhythmias in Patients on Maintenance Hemodialysis

Cited by 32 publications

References 19 publications

Dialysis-Induced Regional Left Ventricular Dysfunction Is Ameliorated by Cooling the Dialysate

Dialysis-Induced Regional Left Ventricular Dysfunction Is Ameliorated by Cooling the Dialysate

Patterns of Cardiac Arrhythmia in Haemodialysis Patients

Prevention of Sudden Cardiac Death in Dialysis Patients: A Nephrologist's Perspective

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