Pattern and Predictors of Cardiac Rhythm Disturbances in Patients on Maintenance Hemodialysis

Author(s): Md. Saiful Ahammad Sarker, Asia Khanam, Md. Fakhrul Islam Khaled, S. M. Remin Rafi, Afrin Akter, Anjuman Ara Daisy, SK Afsana Hossain, H. M. Mohiuddin Alamgir, Mohammad Kamrul Hasan.

Background: Sudden cardiac death (SCD) is the major cause of death among patients on maintenance hemodialysis. It is closely associated with cardiovascular and metabolic changes occurring in patients undergoing hemodialysis. Cardiac arrhythmias were frequently observed in these dialysis patients. Aim of the study: To detect the pattern and predictors of cardiac rhythm disturbances in maintenance hemodialysis patient. Methods: This cross-sectional study was conducted in the Department of Nephrology at BSMMU, Dhaka. A total of 49 patients on maintenance hemodialysis were included based on selection criteria. After inclusion, ECG & echocardiogram were performed on non-dialysis day. On dialysis day, 24-hour Holter ECG monitoring, selective pre & post dialytic laboratory investigations were carried out. The sampling method used was purposive sampling. Data were collected using a predesigned data collection sheet, including patient history and clinical examination. Statistical analyses of the results were performed using software with SPSS-26. Result: The mean age of the study cohort was 42.1 ± 12.3 years, with a predominance of male patients (73.5%). The primary etiology of renal failure was glomerulonephritis (46.9%), followed by diabetes mellitus (36.7%) and hypertension (16.3%). Echocardiographic assessment revealed a mean left ventricular mass index (LVMI) of 130.6 ± 43.7 g/m². Pulmonary artery systolic pressure (PASP) was significantly elevated in patients with tachyarrhythmia (37.7 ± 15.1 mmHg) compared to those without (29.4 ± 13.3 mmHg, p<0.05). Supraventricular arrhythmias were frequent, with premature atrial contractions (PACs) observed in 77.6% of patients; PAC burden averaged 2.49 ± 8.60 per hour, and 8.2% had >70 PACs/day. Ventricular arrhythmias, predominantly premature ventricular contractions (PVCs), occurred in 71.4%, with a mean rate of 0.61 ± 1.22 per hour; 5.7% exhibited a PVC burden between 5–10%. Bradyarrhythmias and tachyarrhythmias were present in 59.2% and 65.3% of patients, respectively. Logistic regression identified significant associations of PACs with post-dialysis magnesium levels, and PVCs with post-dialysis potassium, magnesium, LVMI, and PASP. No correlation was found between arrhythmias and dialysis access type or frequency. Conclusion: Arrhythmias including significant abnormal rhythms, were common but their burden was less. Tachyarrhythmias occurred more often during and immediately after dialysis where bradyarrhythmias were less prevalent in initial period & increased with time. Further study is needed to determine their impact on clinical outcomes.