Managing the risk of cardiac arrhythmias in patients with worsening renal function

This article explores key issues for management of patients with worsening renal function and cardiac arrhythmias, to enable clinicians to provide relevant support and monitoring for these relatively high-risk patients. The implications for arrhythmia inherent to renal failure, haemodialysis and peritoneal dialysis are reviewed, as is the higher prevalence of atrial fibrillation (AF) in those with renal failure—medication and treatment options are outlined. Recommendations are given around dialysis in terms of managing fluid volumes to reduce potential complications of dialysis such as left ventricular hypertrophy, heart failure and hyper/hypotension. In terms of ICD implantation the current evidence is reviewed, along with the role of the nurse in helping patients understand the risk versus benefit of device therapy. The opportunity to work collaboratively across specialisms is recommended and discussed; this may take the form of shared decision making, agreement of optimum follow-up/ monitoring schedules and provision of education.