Intradialytic Arrhythmias Among Patients with End Stage Renal Disease on Maintenance Hemodialysis at Muhimbili National Hospital

Abstract

Background

Arrhythmias are responsible for almost 2 out of 3 cardiac deaths among patients on hemodialysis. We report the prevalence and risk factors for clinically significant arrhythmias among end stage renal disease (ESRD) patients on maintenance dialysis at a tertiary dialysis facility in Tanzania.

Methods

Cross-sectional study, involving consenting adults with ESRD was conducted September 2019 to February 2020. Arrhythmias were assessed using standard 5-leads Holter electrocardiography placed 15 minutes before dialysis and connected throughout dialysis. Clinically Significant Arrhythmias (CSA) was defined as ectopic beats in excess of 10 per hour or any of the ventricular tachycardia or Pause lasting for at least 2.5 seconds or paroxysmal supraventricular tachycardia or atrial flutter or atrial fibrillation.

Results

A total of 71 (44.4%) participants had CSA. Factors associated with increased risk for CSA were: age older than 60 years (OR 34; 95% CI: 5.15-236; P< 0.001), intradialytic blood pressure change of ≥ 10mmHg (OR 3.85; 95% CI: 1.27-11.7; P=0.017) and the presence of Left Ventricular Hypertrophy (OR 5.84; 95% CI: 1.85-18.4; P< 0.01). On the contrary, three dialysis sessions per week (OR 0.14; 95% CI: 0.03-0.67; P=0.013) and use of beta-blockers (OR 0.18; 95% CI: 0.05-0.68; P=0.011) were significantly associated with a decreased risk of CSA.

Conclusion

Clinically significant arrhythmias are not uncommon in ESRD patients undergoing maintenance haemodialysis. We recommend increasing vigilance for CSA among older patients (>60 years) as well as those with left ventricular hypertrophy. Beta blockers among hypertensive ESRD patients with ventricular hypertrophy could be helpful.

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