Franczyk Beata, Rysz Jacek, Olszewski Robert, Gluba-Sagr Anna
Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-419 Lodz, Poland.
Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland.
J Clin Med. 2024 Feb 19;13(4):1176. doi: 10.3390/jcm13041176.
Chronic kidney disease patients appear to be predisposed to heart rhythm disorders, including atrial fibrillation/atrial flutter, ventricular arrhythmias, and supraventricular tachycardias, which increase the risk of sudden cardiac death. The pathophysiological factors underlying arrhythmia and sudden cardiac death in patients with end-stage renal disease are unique and include timing and frequency of dialysis and dialysate composition, vulnerable myocardium, and acute proarrhythmic factors triggering asystole. The high incidence of sudden cardiac deaths suggests that this population could benefit from implantable cardioverter-defibrillator therapy. The introduction of implantable cardioverter-defibrillators significantly decreased the rate of all-cause mortality; however, the benefits of this therapy among patients with chronic kidney disease remain controversial since the studies provide conflicting results. Electrolyte imbalances in haemodialysis patients may result in ineffective shock therapy or the appearance of non-shockable underlying arrhythmic sudden cardiac death. Moreover, the implantation of such devices is associated with a risk of infections and central venous stenosis. Therefore, in the population of patients with heart failure and severe renal impairment, periprocedural risk and life expectancy must be considered when deciding on potential device implantation. Harmonised management of rhythm disorders and renal disease can potentially minimise risks and improve patients' outcomes and prognosis.
慢性肾脏病患者似乎易患心律紊乱，包括心房颤动/心房扑动、室性心律失常和室上性心动过速，这些会增加心源性猝死的风险。终末期肾病患者心律失常和心源性猝死的病理生理因素较为独特，包括透析的时间和频率、透析液成分、易损心肌以及触发心搏停止的急性促心律失常因素。心源性猝死的高发生率表明，这一人群可能受益于植入式心脏复律除颤器治疗。植入式心脏复律除颤器的引入显著降低了全因死亡率；然而，由于研究结果相互矛盾，这种治疗方法在慢性肾脏病患者中的益处仍存在争议。血液透析患者的电解质失衡可能导致电击治疗无效或出现不可电击的潜在心律失常性心源性猝死。此外，植入此类装置存在感染和中心静脉狭窄的风险。因此，在心力衰竭和严重肾功能损害患者群体中，决定是否潜在植入装置时必须考虑围手术期风险和预期寿命。心律失常和肾脏疾病的统一管理有可能将风险降至最低，并改善患者的结局和预后。
