Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Am J Kidney Dis. 2020 Feb;75(2):214-224. doi: 10.1053/j.ajkd.2019.06.012. Epub 2019 Sep 18.
RATIONALE & OBJECTIVE: Patients with kidney failure treated with maintenance dialysis experience a high rate of mortality, in part due to sudden cardiac death caused by arrhythmias. The prevalence of arrhythmias, including the subset that are clinically significant, is not well known. This study sought to estimate the prevalence of arrhythmias, characterize the pattern of arrhythmic events in relation to dialysis treatments, and identify associated clinical characteristics.
Cross-sectional study.
SETTING & PARTICIPANTS: 152 patients with kidney failure treated with maintenance dialysis in Denmark.
Dialysis treatment; clinical characteristics; cardiac output and preload defined using echocardiography.
Prevalence and pattern of arrhythmias on 48-hour Holter monitoring; odds ratios for arrhythmias.
Descriptive analysis of the prevalence of arrhythmias. Pattern of arrhythmias described using a repeated-measures negative binomial regression model. Associations between clinical characteristics and echocardiographic findings with arrhythmias were assessed using logistic regression.
Among the 152 patients studied, 83.6% were treated with in-center dialysis; 10.5%, with home hemodialysis; and 5.9%, with peritoneal dialysis. Premature atrial and ventricular complexes were seen in nearly all patients and 41% had paroxysmal supraventricular tachycardia. Clinically significant arrhythmias included persistent atrial fibrillation observed among 8.6% of patients, paroxysmal atrial fibrillation among 3.9%, nonsustained ventricular tachycardia among 19.7%, bradycardia among 4.6%, advanced second-degree atrioventricular block among 1.3%, and third-degree atrioventricular block among 2.6%. Premature ventricular complexes were more common on dialysis days, while tachyarrhythmias were more often observed during dialysis and in the immediate postdialytic period. Older age (OR per 10 years older, 1.53; 95% CI, 1.15-2.03; P=0.003), elevated preload (OR, 4.02; 95% CI, 1.05-15.35; P=0.04), and lower cardiac output (OR per 1L/min greater, 0.66; 95% CI, 0.44-1.00; P=0.05) were independently associated with clinically significant arrhythmias.
Arrhythmia monitoring limited to 48 hours; small sample size; heterogeneous nature of the population, risk for residual confounding.
Arrhythmias, including clinically significant abnormal rhythms, were common. Tachyarrhythmias were more frequent during dialysis and the immediate postdialytic period. The relevance of these findings to clinical outcomes requires additional study.
接受维持性透析治疗的肾衰竭患者死亡率较高，部分原因是心律失常导致的突发性心脏死亡。心律失常的发生率，包括具有临床意义的心律失常亚组，目前尚不清楚。本研究旨在评估心律失常的发生率，描述与透析治疗相关的心律失常事件模式，并确定相关的临床特征。
横断面研究。
丹麦 152 名接受维持性透析治疗的肾衰竭患者。
透析治疗；临床特征；使用超声心动图定义心输出量和前负荷。
在 152 名研究对象中，83.6%接受中心透析治疗；10.5%接受家庭血液透析；5.9%接受腹膜透析。几乎所有患者都出现了过早的房性和室性复合波，41%的患者出现了阵发性室上性心动过速。具有临床意义的心律失常包括 8.6%的患者持续性心房颤动，3.9%的患者阵发性心房颤动，19.7%的患者非持续性室性心动过速，4.6%的患者心动过缓，1.3%的患者高级二度房室传导阻滞，2.6%的患者三度房室传导阻滞。透析日更常见室性早搏，而心动过速更常发生在透析期间和透析后即刻。年龄每增加 10 岁，（OR，1.53；95%CI，1.15-2.03；P=0.003），前负荷升高（OR，4.02；95%CI，1.05-15.35；P=0.04），心输出量降低（OR，每增加 1L/min，0.66；95%CI，0.44-1.00；P=0.05）与具有临床意义的心律失常独立相关。
心律失常监测时间限制在 48 小时内；样本量小；人群异质性，存在残余混杂的风险。
心律失常，包括具有临床意义的异常节律，很常见。透析期间和透析后即刻心动过速更频繁。这些发现对临床结果的相关性需要进一步研究。
