What is the clinical evidence from this study?

Study design: Observational. Population: Maintenance hemodialysis (n=66). Intervention: Intradialytic hypotension (IDH 20) vs. No intradialytic hypotension. Primary outcome: Clinically significant arrhythmia during hemodialysis (IRR 9.4, 95% CI 3.0-29.4).

May 7, 2020Open Access

Intradialytic Hypotension and Cardiac Arrhythmias in Patients Undergoing Maintenance Hemodialysis

Key Result

Intradialytic hypotension (decline in systolic BP >20 mm Hg) was associated with a nine-fold greater rate of clinically significant arrhythmia during hemodialysis (IRR 9.4; 95% CI 3.0-29.4).

Study Design

Type

Observational (n=66)

Multicenter

Yes

Structured PICO

Does intradialytic hypotension increase the risk of clinically significant arrhythmias in patients undergoing maintenance hemodialysis?

Population

66 patients on maintenance hemodialysis from the United States and India, median age 58, 70% male, monitored with implantable loop recorders over a 6-month period (4720 sessions).

Intervention

Intradialytic hypotension (IDH 20: decline in systolic BP >20 mm Hg from predialysis systolic BP, or IDH 0-20: decline in systolic BP 0-20 mm Hg)

Comparator

Hemodialysis sessions without intradialytic hypotension

Outcome

Clinically significant arrhythmia (bradycardia ≤40 bpm for ≥6 seconds, asystole ≥3 seconds, ventricular tachycardia ≥130 bpm for ≥30 seconds, or patient-marked events) during hemodialysiscomposite

Intradialytic hypotension is strongly associated with an increased risk of clinically significant arrhythmias during hemodialysis sessions.

Main Result

Effect estimate: IRR 9.4 (95% CI 3.0-29.4)

Abstract

Background and objectives Patients receiving maintenance hemodialysis (HD) have a high incidence of cardiac events, including arrhythmia and sudden death. Intradialytic hypotension (IDH) is a common complication of HD and is associated with development of reduced myocardial perfusion, a potential risk factor for arrhythmia. Design, setting, participants, 70% were male; and 65% were from the United States. IDH occurred in 2251 (48%) of the 4720 HD sessions analyzed, whereas IDH 0–20 occurred during 1773 sessions (38%). The number of sessions complicated by least one intradialytic clinically significant arrhythmia was 27 (1.2%) where IDH 20 occurred and 15 (0.8%) where IDH 0–20 occurred. Participants who experienced IDH 20 (versus not) had a nine-fold greater rate of developing an intradialytic clinically significant arrhythmia (incidence rate ratio, 9.4; 95% confidence interval, 3.0 to 29.4), whereas IDH 0–20 was associated with a seven-fold higher rate (incidence rate ratio, 7.2; 95% confidence interval, 2.1 to 25.4). Conclusions IDH is common in patients on maintenance HD and is associated with a greater risk of developing intradialytic clinically significant arrhythmia.

KI fragen

Bookmark

View Full Paper