Associations of Hemodialysis Procedures with Stimulation of Supraventricular Arrhythmias

Evidence suggests higher mortality after two-day gaps in thrice-weekly hemodialysis, with mortality increases of 20-40%. Supraventricular arrhythmias (SVAs), notably atrial fibrillation, are common during dialysis, increasing mortality risk. Hemodialysis induces fluid, electrolyte, and hemodynamic shifts, precipitating arrhythmias. Investigating these associations is crucial for devising preventive strategies and improving outcomes in haemodialysis patients. Materials and Methods: A Holter 24-hour electrocardiogram (ECG) was recorded in 72 hemodialysis patients starting at the beginning of the first session of the week. The associations between an increase in supraventricular premature contractions (SVPCs) during hemodialysis and peridialytic changes in blood electrolytes, mean arterial pressure (MAP), ultrafiltration volume (UFR/DW), ultrasonic cardiographic (UCG) parameters, and other factors were tested using multiple regression analysis. Patients' backgrounds were also compared among tertiles of 24-hour total SVPC counts. Results: SVPCs increased during hemodialysis and six patients developed atrial fibrillation, and 25% maintained low SVPC rates throughout the recording. Patients in the highest tertile for 24-hour SVPC counts had the lowest body mass index (BMI) and the fewest cardiovascular diseases (CVD). They also had the smallest left atrial (LAD) and left ventricular end-systolic dimensions (LVDs). Multiple regression analysis showed that larger changes in mean arterial pressure (MAP) during dialysis were significantly associated with a higher percentage increase in SVPC in all four models. Smaller LAD and larger ultrafiltration volumes (UFR/DW) were also associated with a percentage increase in SVPC. Conclusions: Larger changes in intradialytic mean arterial blood pressure caused by excessive ultrafiltration may increase the risk of developing SVPCs during hemodialysis, particularly in undernourished patients.