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Yu L, Huang J, Li Y, Li H. Brain natriuretic peptide is a biomarker of atrial fibrillation in hemodialysis patients. Ren Fail 2025; 47:2463563. [PMID: 39980306 PMCID: PMC11849019 DOI: 10.1080/0886022x.2025.2463563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 01/27/2025] [Accepted: 02/01/2025] [Indexed: 02/22/2025] Open
Abstract
OBJECTIVES Atrial fibrillation (AF) is the most common persistent arrhythmia and has adverse outcomes in hemodialysis patients. It is obscure the relationship between BNP and AF in hemodialysis patients. This study investigated the interventionable predictors of AF in hemodialysis patients. METHODS In this retrospectively observational cohort study, a total of 205 hemodialysis patients were screened and 140 were enrolled. The anthropometrics, laboratory parameters, electrocardiogram and echocardiogram were collected. The patients were divided into three groups based on the tertiles of BNP value. Kaplan-Meier curves were used to compare the incidence of AF among different BNP groups. Restricted cubic spline curves and receiver operator characteristic curves were drawn, and Cox proportional hazards models were applied to identify the predictive value of BNP and the other related factors for incident AF. RESULTS During the 5-year follow-up period, 33 (23.6%) individuals developed incident AF. The incidence of AF increased significantly with an increase in the BNP. Cox proportional hazards models indicated that age, dialysis vintage, left atrial diameter, ultrafiltration rate, hs-CRP and BNP were independent risk factors for incident AF. The hazard ratios of BNP (per 100 pg/mL) were 1.038 (95% confidence interval, 1.012-1.064, p = 0.004). BNP had a predictive value for the occurrence of AF (area under the curve = 0.734). CONCLUSIONS BNP was a good predictor of incident AF in hemodialysis patients. Higher BNP had an increasing adverse event rate of AF. Further research should be needed to clarify the best reference range of BNP in hemodialysis patients.
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Affiliation(s)
- Ling Yu
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jia Huang
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yanchun Li
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Han Li
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Kofod DH, Diederichsen SZ, Bomholt T, Andersen MØ, Andersen A, Mannheimer E, Rix M, Liem YS, Lindhard K, Hansen HP, Rydahl C, Lindhardt M, Brøsen J, Schandorff K, Lange T, Nørgaard K, Almdal TP, Svendsen JH, Feldt-Rasmussen B, Hornum M. Cardiac arrhythmia and hypoglycaemia among individuals with and without diabetes receiving haemodialysis (the CADDY study): a Danish multicentre cohort study. Diabetologia 2025; 68:1126-1139. [PMID: 40019498 PMCID: PMC12069408 DOI: 10.1007/s00125-025-06388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 01/20/2025] [Indexed: 03/01/2025]
Abstract
AIMS/HYPOTHESIS We aimed to examine arrhythmias and hypoglycaemia among individuals with and without diabetes who are receiving haemodialysis and to investigate the association between arrhythmias and hypoglycaemia, hyperglycaemia and glycaemic variability. METHODS This prospective multicentre cohort study included 70 participants on maintenance haemodialysis (35 with diabetes and 35 without diabetes). We employed implantable cardiac monitors for continuous heart rhythm monitoring in combination with periodic use of continuous glucose monitoring. Logistic-regression-type linear mixed models were used to examine associations between arrhythmias and glycaemic measures. RESULTS During 18 months of follow-up, clinically significant arrhythmias (bradyarrhythmia and ventricular tachycardia) were identified in 12 (34%) participants with diabetes and 11 (31%) without diabetes. Atrial fibrillation was detected in 13 (37%) participants with diabetes and 14 (40%) without, while other supraventricular tachycardia was detected in seven (20%) and 11 (31%) participants with and without diabetes, respectively. Hypoglycaemia (sensor glucose <3.9 mmol/l) was observed in 27 (77%) participants with diabetes and 32 (91%) without diabetes. Compared with euglycaemia, hypoglycaemia was associated with an increased rate of arrhythmias among participants without diabetes (incidence rate ratio [IRR] 3.13 [95% CI 1.49, 6.55]), while hyperglycaemia (sensor glucose >10.0 mmol/l) was associated with a decreased rate of arrhythmias among participants with diabetes (IRR 0.58 [95% CI 0.37, 0.92]). Glycaemic variability showed no association with arrhythmias regardless of the presence of diabetes. CONCLUSIONS/INTERPRETATION Arrhythmias and hypoglycaemia were common in those undergoing haemodialysis regardless of diabetes status. Our data suggest a temporal relationship between arrhythmias and glucose level in both individuals with and without diabetes. TRIAL REGISTRATION Clinicaltrials.gov: NCT04841304.
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Affiliation(s)
- Dea H Kofod
- Department of Nephrology and Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Søren Z Diederichsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tobias Bomholt
- Department of Nephrology and Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mads Ø Andersen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Andreas Andersen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Ebba Mannheimer
- Department of Nephrology and Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marianne Rix
- Department of Nephrology and Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ylian S Liem
- Department of Nephrology and Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kristine Lindhard
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Henrik P Hansen
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Casper Rydahl
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Morten Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital - Holbeak, Holbeak, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Brøsen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Kristine Schandorff
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Nørgaard
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas P Almdal
- Department of Nephrology and Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper H Svendsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology and Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mads Hornum
- Department of Nephrology and Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sunagawa D, Imamura Y, Matsumura S, Inoue H, Wakabayashi H, Hayashi T, Takahashi Y, Joki N. Lower dry weight is associated with post-hemodialysis hypokalemia. Ther Apher Dial 2025; 29:365-374. [PMID: 39900525 DOI: 10.1111/1744-9987.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 01/23/2025] [Accepted: 01/28/2025] [Indexed: 02/05/2025]
Abstract
INTRODUCTION Serum potassium levels <3 mEq/L at post-hemodialysis (HD) are closely associated with poor prognosis. This study aimed to identify high-risk patients with post-HD hypokalemia after regular HD using potassium (2 mEq/L) dialysate solution. METHODS A total of 129 patients receiving HD and 1121 HD sessions were enrolled in this single-center retrospective cross-sectional study. The association of post-HD hypokalemia less than 3 mEq/L with patient background, as well as each dialysis session was investigated. RESULTS Approximately 16% of 129 patients and 10% of 1121 sessions showed post-HD hypokalemia. In per-patient analysis, more inpatients and lower dry weight were found in the hypokalemia group compared with the non-hypokalemia group. Logistic regression analysis indicated that lower dry weight was significantly associated with higher risk of hypokalemia independent of inpatients (p < 0.01). To determine the best cut-off value of pre-HD potassium for identifying post-HD hypokalemia, receiver operating curve analysis was performed in per-session analysis. The results showed that the optimal pre-HD potassium cut-off value was 4.2 mEq/L. In the 250 sessions below the optimal cut-off value for post-HD hypokalemia development, 28.8% of sessions with potassium correction showed post-HD hypokalemia, compared to 40.8% of sessions without potassium correction. Although numerically lower, the difference did not reach statistical significance (p = 0.125). CONCLUSION Our results indicated that a relatively lower dry weight was more likely to complicate post-HD hypokalemia. Potassium supplementation for high-risk patients during HD sessions may be needed to prevent post-HD hypokalemia.
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Affiliation(s)
- Daigo Sunagawa
- Division of Dialysis Center, Nissan Tamagawa Hospital, Tokyo, Japan
| | | | - Saeko Matsumura
- Division of Dialysis Center, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Hiromitsu Inoue
- Division of Dialysis Center, Nissan Tamagawa Hospital, Tokyo, Japan
| | | | | | | | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
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Sakhare Y, Almeida A, Phalgune D, Erande A, Mehendale SM. The Frequency, Causes and Patterns of Asymptomatic Cardiac Arrhythmias in Patients on Maintenance Hemodialysis. Indian J Nephrol 2025; 35:397-401. [PMID: 40352881 PMCID: PMC12065607 DOI: 10.25259/ijn_412_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/31/2024] [Indexed: 05/14/2025] Open
Abstract
Background The knowledge of the incidence of non-severe and clinically significant arrhythmias is limited in patients with chronic kidney disease (CKD). The present study was conducted to determine the incidence, pattern and identify the factors predisposing to cardiac arrhythmias in patients on maintenance hemodialysis. Materials and Methods Forty-five patients were included in this prospective observational study conducted between June 2020 and November 2021. Patients ≥ 18 years of age on maintenance hemodialysis (three times/week for at least three months), with no intercurrent illness, uremic symptoms, and not hospitalized in the previous 3 months were included. Demographic and clinical characteristics of the patients were noted. Arrhythmias were recorded by attaching the Holter machine to all study patients undergoing hemodialysis. We estimated the incidence, identified the pattern of cardiac arrhythmias, and explored the factors predisposing to cardiac arrhythmias. Results Premature atrial complexes (17.8%), premature ventricular complexes (31.1%), ventricular bigeminy (8.9%), trigeminy (8.9%), and ventricular couplets (22.2%) were observed. The patients with hyperparathyroidism, hyper/hypomagnesemia, and poor blood pressure control had significantly higher percentages of total and ventricular arrhythmias. The patients with hypomagnesemia, reduced left ventricular ejection fraction (<50%), poor blood pressure control, and receiving statins had significantly higher percentages of atrial arrhythmias. There was no statistically significant association between age, gender, diabetes mellitus, ischaemic heart disease, interdialytic weight gain, dialysis vintage, low hemoglobin, serum calcium levels, serum potassium levels, presence of left ventricular hypertrophy, pulmonary hypertension, and diastolic dysfunction with arrhythmias. Conclusion A high incidence of cardiac arrhythmias was noted among patients on hemodialysis.
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Affiliation(s)
- Yamita Sakhare
- Department of Nephrology, P D Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, India
| | - Alan Almeida
- Department of Nephrology, P D Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, India
| | - Deepak Phalgune
- Department of Research, P D Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, India
| | - Aditi Erande
- Department of Research, P D Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, India
| | - Sanjay Madhav Mehendale
- Department of Research, P D Hinduja National Hospital and Medical Research Centre, Mahim, Mumbai, India
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Truyen TTTT, Uy-Evanado A, Holmstrom L, Reinier K, Chugh H, Jui J, Herzog CA, Chugh SS. Sudden Cardiac Arrest Associated with Hemodialysis: A Community-Based Study. KIDNEY360 2025; 6:805-813. [PMID: 39823188 DOI: 10.34067/kid.0000000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 01/13/2025] [Indexed: 01/19/2025]
Abstract
Key Points
Around 25% of sudden cardiac arrest (SCA) cases among dialysis patients were associated with the dialysis procedure, a rate nearly three times higher than expected by chance.SCA events were more likely to occur on dialysis days, especially after long interdialytic periods, such as on Mondays and Tuesdays.A significant portion (23.4%) of SCA events associated with dialysis occurred within the first hour postdialysis, highlighting the need for careful monitoring.
Background
Individuals with ESKD may be at increased risk of sudden cardiac arrest (SCA) associated with dialysis therapy. However, community-based studies with comprehensive adjudication of SCA are lacking.
Methods
We conducted a community-based study using a case-case study design in a US population of approximately 1 million. All SCA cases with CKD were ascertained prospectively (2002–2020). We reviewed emergency medical services narratives and archived medical records from regional hospitals to capture patients' dialysis history, schedules, and the timing of SCA events in relation to dialysis sessions. Among those on regular hemodialysis, individuals who suffered SCA during hemodialysis or within an hour after completing hemodialysis (intradialytic/immediate posthemodialysis [IIHD]) were compared to cases with SCA at other times (non-IIHD). Noncompliant individuals or those intolerant of dialysis were excluded.
Results
Of 1023 SCA cases with CKD, 195 (19.1%) were undergoing regular scheduled hemodialysis. Among these cases, 24.1% were IIHD SCA, while 75.9% occurred non-IIHD. The incidence of SCA during dialysis was 2.9 times higher than expected by chance. SCA events were more likely to occur on dialysis days (65.3% of events) versus 34.7% events on the four off dialysis days (P < 0.001). IIHD SCA had higher serum sodium (138.9±4.8 versus 135.5±5.5 mmol/L, P = 0.005), lower serum potassium (3.6±0.7 versus 5.6±1.6 mmol/L, P < 0.001), and higher bicarbonate levels (25.9±6.6 versus 20.2±5.5 mmol/L, P < 0.001) compared with their non-IIHD SCA counterparts. Regarding resuscitation details, IIHD SCA had a higher percentage of shockable rhythm (46.5% versus 32.4%, P = 0.09), witnessed collapse (85.1% versus 53.4%, P < 0.001), bystander cardiopulmonary resuscitation (72.3% versus 37.9%, P < 0.001), return of spontaneous circulation (66.0% versus 42.5%, P = 0.005), and survival to hospital discharge (30.4% versus 5.4%, P < 0.001) compared with non-IIHD SCA.
Conclusions
In patients undergoing dialysis, SCA events were significantly more common on dialysis days and three-fold higher than expected by chance. We identified potential risk factors and survival outcome differences between IIHD versus non-IIHD SCA groups that warrant future investigation.
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Affiliation(s)
- Thien Tan Tri Tai Truyen
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Audrey Uy-Evanado
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Lauri Holmstrom
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Harpriya Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin Healthcare/University of Minnesota, Minneapolis, Minnesota
| | - Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California
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Stamellou E, Georgopoulos C, Lakkas L, Dounousi E. 10 tips on how to manage severe arrhythmia in haemodialysis patients. Clin Kidney J 2025; 18:sfaf072. [PMID: 40226367 PMCID: PMC11986812 DOI: 10.1093/ckj/sfaf072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Indexed: 04/15/2025] Open
Abstract
Cardiovascular disease, particularly life-threatening ventricular arrhythmias and sudden cardiac death (SCD), remains the leading cause of death among haemodialysis (HD) patients, with an alarmingly higher incidence compared with the general population. By addressing key risk factors such as electrolyte imbalances, fluid overload and ultrafiltration rates, focusing on practical interventions and incorporating multidisciplinary care, clinicians can significantly reduce the risk of fatal arrhythmias. Here we propose 10 practical tips to guide clinicians in managing severe arrhythmias in HD patients. Each tip provides actionable insights for identifying high-risk individuals, with an emphasis on prevention and multidisciplinary care.
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Affiliation(s)
- Eleni Stamellou
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece
- Department of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | | | - Lampros Lakkas
- Department of Physiology, University of Ioannina Medical School, University Campus, Ioannina, Greece
| | - Evangelia Dounousi
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece
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Tsuyuki T, Kitamura M, Fukuda H, Ishii T, Torigoe K, Yamashita H, Takazono T, Sakamoto N, Mukae H, Nishino T. Prognostic differences between pre-existing atrial fibrillation in chronic kidney disease and new-onset atrial fibrillation at hemodialysis initiation: a retrospective single-center cohort study. PLoS One 2025; 20:e0320336. [PMID: 40131887 PMCID: PMC11936237 DOI: 10.1371/journal.pone.0320336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Accepted: 02/16/2025] [Indexed: 03/27/2025] Open
Abstract
Atrial fibrillation (AF) can develop in patients with chronic kidney disease. However, the impact of new-onset AF in patients who are initiated on hemodialysis remains unclear. We categorized 254 patients who were started on hemodialysis into three groups: those with pre-existing AF, those with new-onset AF, and those without AF. Statistical analyses were performed to evaluate the associations between patient characteristics and survival outcomes. AF was observed in 42 patients (16.5%), of whom 19 (7.5%) had pre-existing AF and 23 (9.1%) developed new-onset AF at the initiation of hemodialysis. Multivariate logistic regression models showed that only low serum albumin levels were associated with AF (P = 0.04). Age- and other factors-adjusted multivariable Cox regression models indicated that AF, particularly pre-existing AF, was an independent risk factor for death after dialysis initiation (hazard ratio [HR]: 2.28, 95% confidence interval [CI]: 1.39-3.74, P = 0.001; HR: 3.05, 95% CI: 1.64-5.66, P = 0.004, respectively). However, new-onset AF was not significantly associated with mortality (HR: 1.43, 95% CI: 0.74-2.78, P = 0.28). These findings suggest that pre-existing AF before hemodialysis initiation has a crucial impact on patient prognosis.
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Affiliation(s)
- Tomohisa Tsuyuki
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
- Department of Nephrology, Japan Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Haruka Fukuda
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Takuma Ishii
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Kenta Torigoe
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Yamashita
- Department of Nephrology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Genovesi S, Lieti G, Camm AJ. Sudden cardiac death in patients with kidney failure on renal replacement therapy: An unsolved problem. Heart Rhythm 2025:S1547-5271(25)02232-5. [PMID: 40122199 DOI: 10.1016/j.hrthm.2025.03.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Revised: 03/13/2025] [Accepted: 03/17/2025] [Indexed: 03/25/2025]
Abstract
Sudden cardiac death is an important cause of mortality in patients with kidney failure undergoing renal replacement therapy, either hemodialysis or peritoneal dialysis. The risk factors associated with sudden cardiac death in these patients only partly overlap with those in the general population. Kidney failure per se and hemodialysis therapy expose these patients to an increased risk of sudden cardiac death compared with individuals with preserved renal function. Studies of the implantable cardioverter defibrillator for primary prevention of sudden cardiac death in patients with kidney failure have failed to demonstrate its usefulness. Moreover, the incidence of complications associated with cardiac electronic device implantation in this population is extremely high. This review aims to provide an update on the available studies on the pathophysiology and prevention of sudden cardiac death in patients with kidney failure undergoing dialysis and to propose the adoption of clinical practices to reduce its incidence.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, Nephrology Clinic, Monza, Italy; Istituto Auxologico Italiano, IRCCS, Milan, Italy.
| | - Giulia Lieti
- UO Nefrologia e Dialisi, ASST-Rhodense, Garbagnate Milanese, Milan, Italy
| | - A John Camm
- City St George's University of London, London, UK
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Truyen TTTT, Uy-Evanado A, Chugh H, Reinier K, Charytan DM, Salvucci A, Jui J, Chugh SS. Moderate Kidney Dysfunction Independently Increases Sudden Cardiac Arrest Risk: A Community-Based Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.03.12.25323871. [PMID: 40162277 PMCID: PMC11952626 DOI: 10.1101/2025.03.12.25323871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
Background Moderate kidney dysfunction is independently associated with increased cardiovascular mortality. Sudden cardiac arrest (SCA) accounts for at least 25% of chronic kidney disease (CKD) mortality. Methods We conducted a case-control study within an ongoing, prospective, community-based investigation of out-of-hospital SCA in the Portland, Oregon, metropolitan area (population ~ 1 million) from February 1st, 2002, to December 31st, 2020. Analysis included individuals aged 40 to 75 who experienced SCA (cases) and individuals with no history of SCA (controls), with creatinine levels measured prior to SCA/enrollment. Moderate CKD was defined by an estimated glomerular filtration rate (eGFR) of 30 to <60 mL/min/1.73 m2 (2021 CKD-EPI formula). A population-based SCA study in Southern California was used for validation. Results We compared 2,068 SCA cases and 852 controls (mean ages: 61.4±8.5 and 62.7±8.0 years; males: 69.9% and 67.4%). SCA cases had more moderate CKD (17.7% vs. 14.7%, p<0.001) and lower eGFR (74.7 vs. 80.9 mL/min/1.73 m2, p<0.001) than controls. Multivariable regression demonstrated that moderate CKD was an independent risk factor for SCA (OR: 1.33, 95% CI: 1.03-1.72). Each 10 mL/min/1.73 m2 eGFR drop below 90 increased SCA risk (OR: 1.24, 95% CI: 1.18-1.31). Similar findings were observed in the validation cohort (817 SCA and 3,249 controls), where moderate CKD was associated with SCA (OR: 1.51, 95% CI: 1.16-1.97). Conclusion Moderate CKD is associated with an increased risk of SCA in the general population. Further research into the potential integration of moderate renal dysfunction into SCA risk stratification are warranted.
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Affiliation(s)
- Thien Tan Tri Tai Truyen
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Audrey Uy-Evanado
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Harpriya Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Kyndaron Reinier
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
| | - David M. Charytan
- Nephrology Division, NYU Grossman School of Medicine, New York, NY, United States
| | - Angelo Salvucci
- Ventura County Health Care Agency, Ventura, CA, United States
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland OR, United States
| | - Sumeet S. Chugh
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, United States
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10
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Carvalho APV, do Carmo GAL, Silva CA, Oliveira AC, Perez LG, do Carmo LPDF, Ribeiro AL. Subclinical Atrial Fibrillation Screening in Dialytic Chronic Kidney Disease Patients Using Portable Device. Arq Bras Cardiol 2025; 122:e20240450. [PMID: 40197938 PMCID: PMC12058139 DOI: 10.36660/abc.20240450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 11/10/2024] [Accepted: 01/15/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Cardiovascular morbidity and mortality rates are higher in hemodialysis (HD) patients, with an increased prevalence of arrhythmias. Atrial fibrillation (AF) is an independent risk factor for mortality and thromboembolic events in dialysis patients. For a better understanding and management of AF in these patients, it is important to know its prevalence. The use of a portable device would be pioneering for this group of patients. OBJECTIVE To screen HD patients for AF using a portable gadget and evaluate the device's diagnostic performance. METHODS HD patients at a tertiary hospital underwent AF screening during HD sessions using MyDiagnostick® (Applied Biomedical Systems). Multiple data were collected to evaluate potential associations. Statistical significance was defined as p < 0.05. RESULTS 388 patients were evaluated (female, 40.7%; mean age of 56.8 years old, SD ± 14.7; and HD time of 27 months, 10-57). Screening was positive in 16 (4.1%) patients. AF was confirmed by electrocardiogram in 7 (1.8%) patients. Male sex (p = 0.019), older age (p = 0.007), altered baseline electrocardiogram (p < 0.001), increased serum potassium (p = 0.021), reduced systolic blood pressure at the beginning of dialysis (p = 0.007), and stable angina (0.011) were associated with positive screening for AF. The device presented a 91.74% specificity (95% CI, 86.65% to 96.91%) and 100% sensitivity (95% CI, 100% to 100%), with a negative predictive value of 100% (95% CI, 100% to 100%) for AF screening. CONCLUSION The use of this device proved to be practical, with high sensitivity and excellent negative predictive value. Subclinical AF has a high prevalence and may be underestimated in this population.
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Affiliation(s)
- Adson Patrik Vieira Carvalho
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilFaculdade de Medicina – Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Gabriel Assis Lopes do Carmo
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilFaculdade de Medicina – Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Cassia Aparecida Silva
- Departamento de CardiologiaHospital São Francisco de AssisBelo HorizonteMGBrasilDepartamento de Cardiologia – Hospital São Francisco de Assis, Belo Horizonte, MG – Brasil
| | - Ana Cecília Oliveira
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilFaculdade de Medicina – Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Lucas Giandoni Perez
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilFaculdade de Medicina – Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Lilian Pires de Freitas do Carmo
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilFaculdade de Medicina – Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Antonio L. Ribeiro
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilFaculdade de Medicina – Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil
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11
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Martin SS, Aday AW, Allen NB, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Bansal N, Beaton AZ, Commodore-Mensah Y, Currie ME, Elkind MSV, Fan W, Generoso G, Gibbs BB, Heard DG, Hiremath S, Johansen MC, Kazi DS, Ko D, Leppert MH, Magnani JW, Michos ED, Mussolino ME, Parikh NI, Perman SM, Rezk-Hanna M, Roth GA, Shah NS, Springer MV, St-Onge MP, Thacker EL, Urbut SM, Van Spall HGC, Voeks JH, Whelton SP, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2025; 151:e41-e660. [PMID: 39866113 DOI: 10.1161/cir.0000000000001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2025]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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12
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Winkelmayer WC, Hu A, Khairallah P, Airy M, Erickson KF, Chang TI, Niu J. Oral Anticoagulant Initiation in Patients With Kidney Failure on Hemodialysis Newly Diagnosed With Atrial Fibrillation (2007-2020): An Observational Study of Trends and Disparities. Kidney Med 2025; 7:100926. [PMID: 39844893 PMCID: PMC11750526 DOI: 10.1016/j.xkme.2024.100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2025] Open
Abstract
Rationale & Objective Atrial fibrillation (AF) is common in patients with kidney failure on hemodialysis (HD), but few patients receive oral anticoagulant (OAC) treatment. Availability of direct-target OACs starting in 2010 may have induced greater OAC initiation, but this has not been systematically studied. Study Design Retrospective cohort study. Setting & Participants Using Medicare fee-for-service billing claims (2006-2020), we identified previously OAC-naïve HD patients newly-diagnosed with AF between January 1, 2007, and October 1, 2020. Exposures Calendar year; race/ethnicity. Outcomes OAC initiation within 90 days from AF diagnosis (any; specific agent). Analytical Approach We estimated initiation risk ratios for each calendar year compared with the referent cohort, 2007, using unadjusted and multivariable-adjusted modified Poisson regression. We also determined differences by racial/ethnic group in OAC initiation, as well as any changes in these disparities over time. Results Among 82,389 HD patients newly-diagnosed with AF, 20,002 (24.3%) initiated new OAC treatment within 90 days: 20.5% in 2007 and 34.1% in 2020. Direct-target OACs accounted for 81.0% of OAC initiations in 2020. Adjusted regression models estimated that OAC initiation remained essentially unchanged between 2007 and 2013, but thereafter increased toward a demographics-adjusted risk ratio of 1.61 (95% CI: 1.50-1.73) in 2020. Compared with non-Hispanic Whites, the rates of OAC initiation were 15% (95% CI, 12%-17%) lower among Black patients, 29% (95% CI, 24%-34%) lower among Asian patients, and 22% (95% CI, 19%-25%) lower among Hispanic patients. These disparities were not found to have differed across time (P interaction = 0.75). Limitations Lack of clinical detail to firmly establish contraindications to OAC initiation. Conclusions While rates of OAC initiation among patients on HD with newly-diagnosed AF increased in recent years, predominantly driven by increased use of apixaban, OAC initiation rates remained low, at 34% of patients in 2020. Compared with non-Hispanic White patients, OAC initiation remained consistently lower in patients of other race and ethnic groups.
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Affiliation(s)
| | - Austin Hu
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Pascale Khairallah
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Medha Airy
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Kevin F. Erickson
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Tara I. Chang
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Jingbo Niu
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
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13
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Wood-Kurland HK, Nørskov AS, Carlson N, Greve AM, Køber L, Gislason G, Torp-Pedersen C, Bang CN. The Association Between Chronic Kidney Disease and Third-Degree Atrioventricular Block: A Danish Nationwide Study. JACC Clin Electrophysiol 2025; 11:376-385. [PMID: 39708039 DOI: 10.1016/j.jacep.2024.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 09/04/2024] [Accepted: 10/04/2024] [Indexed: 12/23/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is frequently complicated by arrhythmias, plausibly leading to the increased risk of sudden cardiac death in this population. However, little is known about the association between CKD and third-degree atrioventricular block (3AVB) and need for permanent pacing. OBJECTIVES This study aimed to investigate the association between CKD and 3AVB. METHODS In a population-based nested case-control study, patients with 3AVB were identified between July 1995 and December 2018 using Danish administrative registries. Cases were risk set matched 1:5 with controls on sex and birth year. Multivariable Cox regression was used to analyze the association between CKD and 3AVB, with subsequent logistic regression analyses for computation of odds ratios for pacemaker implantation stratified by dialysis or nondialysis CKD. RESULTS A total of 31,301 patients with 3AVB were identified and matched with 155,506 controls. The mean age was 74.7 ± 12 years, and 40.2% were female. A significant association was found between CKD and 3AVB after adjustment for comorbidities and potential atrioventricular node blocking agents (HR: 1.83; 95% CI: 1.73-1.93). In stratified analyses, the association was stronger in patients using dialysis compared with nondialysis patients (HR: 7.71; 95% CI: 5.84-10.18; vs HR: 1.73; 95% CI: 1.64-1.83). The odds of pacemaker implantation were lower for patients using dialysis (OR: 0.77; 95% CI: 0.60-0.98) but comparable between patients with nondialysis CKD (OR: 1.04; 95% CI: 0.96-1.12) and patients without CKD. CONCLUSIONS CKD was independently associated with a higher rate of 3AVB, especially for patients using dialysis.
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Affiliation(s)
- Hannah K Wood-Kurland
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Cardiology, North Zealand Hospital, Hillerød, Denmark; Royal Library, Copenhagen University Library Incl. UH, Copenhagen, Denmark.
| | - Anne Storgaard Nørskov
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Cardiology, North Zealand Hospital, Hillerød, Denmark
| | | | | | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Gentofte, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Casper N Bang
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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14
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Shringi S, Shah A. The cardiovascular unphysiology of thrice weekly hemodialysis. Curr Opin Nephrol Hypertens 2025; 34:69-76. [PMID: 39498607 PMCID: PMC11606746 DOI: 10.1097/mnh.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2024]
Abstract
PURPOSE OF REVIEW This review examines the unphysiological nature of conventional intermittent hemodialysis (IHD) and explores alternative dialysis modalities that more closely mimic natural kidney function. As cardiovascular complications remain a leading cause of morbidity and mortality in dialysis patients, understanding and addressing the limitations of IHD is crucial for improving outcomes. RECENT FINDINGS IHD's intermittent nature leads to significant fluctuations in metabolites, electrolytes, and fluid status, contributing to hemodynamic instability and increased cardiovascular risk. More frequent dialysis modalities, such as short daily hemodialysis and nocturnal hemodialysis have numerous benefits including reduced left ventricular hypertrophy, improved blood pressure control, and potentially decreasing mortality. Peritoneal dialysis offers a more continuous approach to treatment, which may provide cardiovascular benefits through gentler fluid removal and residual kidney function preservation. SUMMARY Conventional thrice weekly intermittent hemodialysis offers a fundamentally unphysiologic equilibrium of uremic solutes. Alternate approaches have demonstrated cardiovascular benefits.
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Affiliation(s)
- Sandipan Shringi
- Warren Alpert Medical School of Brown University, Providence, RI
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Providence, Rhode Island
| | - Ankur Shah
- Warren Alpert Medical School of Brown University, Providence, RI
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Providence, Rhode Island
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15
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Charytan DM, Winkelmayer WC, Granger CB, Middleton JP, Herzog CA, Chertow GM, Eudicone JM, Whitson JD, Tumlin JA. Effects of dialysate potassium concentration of 3.0 mmol/l with sodium zirconium cyclosilicate on dialysis-free days versus dialysate potassium concentration of 2.0 mmol/l alone on rates of cardiac arrhythmias in hemodialysis patients with hyperkalemia. Kidney Int 2025; 107:169-179. [PMID: 39490411 DOI: 10.1016/j.kint.2024.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 10/11/2024] [Accepted: 10/15/2024] [Indexed: 11/05/2024]
Abstract
The optimal approach towards managing serum potassium (sK+) and hemodialysate potassium concentrations is uncertain. To study this, adults receiving hemodialysis for three months or more with hyperkalemia (pre-dialysis sK+ 5.1-6.5 mmol/l) had cardiac monitors implanted and were randomized to either eight weeks of 2.0 mmol/l potassium/1.25 mmol/l calcium dialysate without sodium zirconium cyclosilicate (SZC) (2.0 potassium/noSZC) or 3.0 mmol/l potassium/1.25 mmol/l calcium dialysate combined with SZC (3.0 potassium/SZC) on non-dialysis days to maintain pre-dialysis sK+ 4.0-5.5 mmol/l, followed by treatment crossover for another eight weeks. The primary outcome was the rate of adjudicated atrial fibrillation (AF) episodes of at least 2 minutes duration. Secondary outcomes included clinically significant arrhythmias (bradycardia, ventricular tachycardia, and/or asystole) and the proportion of sK+ measurements within an optimal window of 4.0-5.5 mmol/l. Among 88 participants (mean age: 57.1 years; 51% male; mean pre-dialysis sK+: 5.5 mmol/l) with 25.5 person-years of follow-up, 296 AF episodes were detected in nine patients. The unadjusted AF rate was lower with 3.0 potassium/SZC versus 2.0 potassium/noSZC; 9.7 vs. 13.4/person-year (modeled rate ratio 0.52; 95% confidence interval 0.41-0.65). Clinically significant arrhythmias were reduced with 3.0 potassium/SZC vs. 2.0 potassium/noSZC (6.8 vs. 10.2/person-year modeled rate ratio 0.47; 0.38; 0.58). Fewer sK+ measurements outside the optimal window occurred with 3.0 potassium/SZC (modeled odds ratio: 0.27; 0.12-0.35). Hypokalemia was less frequent (33 vs. 58 patients) with 3.0 potassium/SZC compared with 2.0 potassium/noSZC. Thus, in patients with hyperkalemia on maintenance hemodialysis, a combination of hemodialysate potassium 3.0 mmol/l and SZC on non-hemodialysis days reduced the rates of AF, other clinically significant arrhythmias, and post-dialysis hypokalemia compared with hemodialysate potassium 2.0/noSZC.
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Affiliation(s)
- David M Charytan
- Division of Nephrology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Wolfgang C Winkelmayer
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher B Granger
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA; Division of Cardiovascular Medicine, Duke University, Durham, North Carolina, USA
| | - John P Middleton
- Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Charles A Herzog
- Cardiology Division, Department of Internal Medicine, Hennepin Healthcare/University of Minnesota, Minneapolis, Minnesota, USA
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - James M Eudicone
- BioPharmaceuticals, Medical Evidence Statistics, AstraZeneca Pharmaceuticals LP, Wilmington, Delaware, USA
| | | | - James A Tumlin
- NephroNet, Atlanta, Georgia, USA; Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
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16
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Ikizler TA, Drueke TB, Floege J, Wong G. Avoiding arrythmias by personalizing the dialysate concentration: a case for precision medicine in patients on dialysis. Kidney Int 2025; 107:18-20. [PMID: 39490412 DOI: 10.1016/j.kint.2024.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Revised: 10/15/2024] [Accepted: 10/15/2024] [Indexed: 11/05/2024]
Abstract
Cardiac arrythmias are common in patients undergoing maintenance hemodialysis. In this issue, Charytan et al. showed that in patients with hyperkalemia (serum potassium concentration 5.10-6.50 mmol/l [5.1-6.5 mEq/l]) on hemodialysis, a dialysate concentration of 3 mEq/l combined with sodium zirconium cyclosilicate on dialysis-free days is associated with a lower frequency of atrial fibrillation compared with a dialysate concentration of 2 mEq/l over 8 weeks. Despite the obvious limitations such as small sample size, short treatment period, and lack of information on longer-term impact on important patient outcomes such as sudden death, this well-conceived pilot study provided impetus for larger prospective trials to test whether this personalized approach reduces major cardiovascular events and mortality.
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Affiliation(s)
- T Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Tilman B Drueke
- Centre de recherche en Epidémiologieet Santé des Populations, Inserm Unit 1018, Team 5, CESP, Paul Brousse Hospital, Paris, France
| | - Jürgen Floege
- Division of Nephrology and Rheumatology, Rheinisch Westfälische Technische Hochschule (RWTH) University of Aachen, Aachen, Germany
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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17
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Reaves AC, Weiner DE, Sarnak MJ. Home Dialysis in Patients with Cardiovascular Diseases. Clin J Am Soc Nephrol 2024; 19:1646-1655. [PMID: 38198166 PMCID: PMC11637708 DOI: 10.2215/cjn.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
Kidney failure with replacement therapy and cardiovascular disease are frequently comorbid. In patients with kidney failure with replacement therapy, cardiovascular disease is a major contributor to morbidity and mortality. Conventional thrice-weekly in-center dialysis confers risk factors for cardiovascular disease, including acute hemodynamic fluctuations and rapid shifts in volume and solute concentration. Home hemodialysis and peritoneal dialysis (PD) may offer benefits in attenuation of cardiovascular disease risk factors primarily through improved volume and BP control, reduction (or slowing progression) of left ventricular mass, decreased myocardial stunning, and improved bone and mineral metabolism. Importantly, although trial data are available for several of these risk factors for home hemodialysis, evidence for PD is limited. Among patients with prevalent cardiovascular disease, home hemodialysis and PD may also have potential benefits. PD may offer particular advantages in heart failure given it removes volume directly from the splanchnic circulation, thus offering an efficient method of relieving intravascular congestion. PD also avoids the risk of blood stream infections in patients with cardiac devices or venous wires. We recognize that both home hemodialysis and PD are also associated with potential risks, and these are described in more detail. We conclude with a discussion of barriers to home dialysis and the critical importance of interdisciplinary care models as one component of advancing health equity with respect to home dialysis.
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Affiliation(s)
- Allison C Reaves
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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18
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Middleton JP, Sun S, Murray S, Davenport CA, Daubert JP. Randomized Trial of Patiromer on Efficacy to Reduce Episodic Hyperkalemia in Patients with ESKD Treated With Hemodialysis. Kidney Int Rep 2024; 9:3218-3225. [PMID: 39534190 PMCID: PMC11551111 DOI: 10.1016/j.ekir.2024.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 07/11/2024] [Accepted: 08/05/2024] [Indexed: 11/16/2024] Open
Abstract
Introduction Individuals with end-stage kidney disease (ESKD) maintained on hemodialysis (HD) carry a high risk of cardiac arrhythmias. This risk is heightened by episodic hyperkalemia. The purpose of the study was to investigate whether patiromer administered daily reduced episodes of hyperkalemia in those with ESKD who receive HD, and to explore whether prescription of patiromer reduced the number of significant arrhythmia events. Methods This was a prospective, randomized, open-label trial. Eligible patients with ESKD on HD were identified. Participants were randomized 1:1 to patiromer versus usual care. Those randomized to patiromer were administered the medication daily, and the dose was titrated based on serum potassium concentrations at the start of weeks 1, 2, and 3. All participants received 7-day continuous cardiac monitors at baseline and at week 4. Results Of the 33 participants who were randomized, 1 withdrew due to adverse symptoms, and 1 withdrew due to pregnancy, leaving 31 in our analytic cohort. The mean age of randomized participants was 56 years, 55% were male, 81% were Black, and 10% were Hispanic/Latino. In week 4, the number of episodes of serum potassium ≥ 5.5 mEq/l was 13 in the patiromer group and 41 in the control group; with median number of episodes of hyperkalemia in the patiromer group significantly lower than that of control group (0 vs. 3, P = 0.024). In week 4 continuous cardiac monitors, 6 participants had > 1000/24 h premature ventricular contractions, 5 had no sustained ventricular tachycardia (VT), 3 had atrial fibrillation, and 1 had bradycardia, with no significant differences between the groups. Conclusion Patiromer administered daily reduced the frequency of hyperkalemia in study participants with ESKD who receive thrice-weekly HD. Larger studies are needed to determine whether patiromer reduces significant cardiac events.
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Affiliation(s)
- John P. Middleton
- Division of Nephrology, Duke Medicine, Duke University, Durham, North Carolina, USA
| | - Shifeng Sun
- Duke University Department of Biostatistics and Bioinformatics, Durham, North Carolina, USA
| | - Susan Murray
- Division of Nephrology, Duke Medicine, Duke University, Durham, North Carolina, USA
| | | | - James P. Daubert
- Division of Nephrology, Duke Medicine, Duke University, Durham, North Carolina, USA
- Division of Cardiology, Duke Medicine, Duke University, Durham, North Carolina, USA
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Ravi KS, Tumlin JA, Roy-Chaudhury P, Koplan BA, Costea AI, Kher V, Williamson D, McClure CK, Charytan DM, Mc Causland FR. Association of Dialysate Bicarbonate with Arrhythmia in the Monitoring in Dialysis Study. KIDNEY360 2024; 5:1490-1499. [PMID: 39480910 PMCID: PMC11556930 DOI: 10.34067/kid.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
Background Sudden death accounts for approximately 25% of deaths among maintenance hemodialysis patients, occurring more frequently on hemodialysis days. Higher dialysate bicarbonate (DBIC) may predispose to alkalemia and arrhythmogenesis. Methods We conducted a 12-month analysis of session-level data from 66 patients with implantable loop recorders. We fit logistic regression and negative binomial mixed-effects regression models to assess the association of DBIC with clinically significant arrhythmia (ventricular tachycardia ≥115 beats per minute [BPM] for at least 30 seconds, bradycardia ≤40 BPM for at least 6 seconds, or asystole for at least 3 seconds) and reviewer confirmed arrhythmia (RCA—implantable loop recorder-identified or patient-marked event for which a manual review of the stored electrocardiogram tracing confirmed the presence of atrial fibrillation, supraventricular tachycardia, sinus tachycardia with rate >130 BPM, ventricular tachycardia, asystole, or bradycardia). Models adjusted for age, sex, race, hemodialysis vintage, vascular access, and prehemodialysis serum bicarbonate and additionally for serum and dialysate potassium levels. Results The mean age was 56±12 years, 70% were male, 53% were Black, and 35% were Asian. Fewer RCA episodes were associated with DBIC >35 than 35 mEq/L (incidence rate ratio 0.45 [0.27 to 0.75] and adjusted incident rate ratio 0.54 [0.30 to 0.97]), but the association was not significant when adjusting for serum and dialysate potassium levels (adjusted incident rate ratio, 0.60 [0.32 to 1.11]). Otherwise, no associations between DBIC and arrhythmia were identified. Conclusions We observed a lower frequency of RCA with higher DBIC, compared with DBIC of 35 mEql/L, contrary to our original hypothesis, but this association was attenuated in fully adjusted models. Validation of these findings in larger studies is required, with a further need for interventional studies to explore the optimal DBIC concentration.
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Grants
- K23 DK127248 NIDDK NIH HHS
- DK 127248 Foundation for the National Institutes of Health, Medtronic, Novartis India, Sanofi Aventis India, Gilead Sciences, NovoNordisk, Amgen, National Institute of Diabetes and Digestive and Kidney Diseases, Satellite Healthcare, Fifth Eye, Lexicon, Foundation for the National Institutes of Health
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Affiliation(s)
- Katherine Scovner Ravi
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Prabir Roy-Chaudhury
- UNC Kidney Center, Chapel Hill, North Carolina
- WG (Bill) Hefner VA Medical Center, Salisbury, North Carolina
| | - Bruce A. Koplan
- Cardiology Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Vijay Kher
- Medanta Kidney and Urology Institute, Medanta The Medicity, Gurugram, India
| | - Don Williamson
- Southeastern Clinical Research Institute, Augusta, Georgia
| | | | - David M. Charytan
- New York University School of Medicine and NYU Langone Medical Center, New York, New York
| | - Finnian R. Mc Causland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Schiedat F, Meuterodt B, Winter J, Prull M, Aweimer A, Gotzmann M, O’Connor S, Perings C, Lawo T, El-Battrawy I, Hanefeld C, Korth J, Mügge A, Kloppe A. Subcutaneous versus Transvenous Implantable Cardioverter Defibrillator in Patients with End-Stage Renal Disease Requiring Dialysis: Extended Long-Term Retrospective Multicenter Follow-Up. J Pers Med 2024; 14:870. [PMID: 39202061 PMCID: PMC11355588 DOI: 10.3390/jpm14080870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICD) prevent sudden cardiac death (SCD). Patients with end-stage renal disease (ESRD) requiring dialysis are at a very high risk of infection from cardiac implantable electronic device (CIED) implantation as well as mortality. In the present study, we compared the long-term complications and outcomes between subcutaneous ICD (S-ICD) and transvenous ICD (TV-ICD) recipients. METHODS In this retrospective analysis, we analyzed a total of 43 patients with ESRD requiring dialysis who received either a prophylactic S-ICD (26 patients) or a single right ventricular lead TV-ICD (17 patients) at seven experienced centers in Germany. Follow-up was performed bi-annually, at the end of which the data concerning comorbidities and, if applicable, reason for death were checked and confirmed with patients' general practitioner, nephrologist and cardiologist. RESULTS The median follow up duration was 95.6 months (range 42.8-126.3 months). Baseline characteristics were without noteworthy significant differences between groups. During follow-up (FU), there were significantly more device-associated infections (HR 8.72, 95% confidence interval (CI), 1.18 to 12.85, p < 0.05) and device-associated hospitalizations (HR 10.20, 95% CI 1.22 to 84.61, p < 0.001), as well as a higher cardiovascular mortality (HR 9.17, 95% CI 1.12 to 8.33, p < 0.05), in the TV-ICD group. The number of patients requiring hospitalization for any reason was significantly higher in the TV-ICD group (HR 2.59, 95% CI 1.12 to 6.41, p < 0.05). There was no significant difference in overall mortality (HR 1.92, 95% CI 0.96 to 6.15, p = 0.274). CONCLUSIONS Our data suggest that, in this extended follow-up in seriously compromised renal patients on dialysis, the S-ICD patients have statistically fewer device infections and hospitalizations as well as lower cardiac mortality compared with the TV-ICD cohort.
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Affiliation(s)
- Fabian Schiedat
- Department of Cardiology and Angiology, Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, 45886 Gelsenkirchen, Germany
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, 44789 Bochum, Germany (A.M.)
| | - Benjamin Meuterodt
- Department of Cardiology, Electrophysiology, Pneumology and Intensive Care Medicine, St. Marien-Hospital Luenen, Academic Hospital of the University Muenster, 44534 Lünen, Germany
| | - Joachim Winter
- Department of Cardiovascular Surgery, Heinrich-Heine University Hospital, 40225 Duesseldorf, Germany
| | - Magnus Prull
- Department of Cardiology, Augusta Hospital Bochum, Academic Hospital of the University Duisburg Essen, 44791 Bochum, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, 44789 Bochum, Germany (A.M.)
| | - Michael Gotzmann
- Department of Cardiology, Katholische Kliniken Bochum of the Ruhr University Bochum, 44791 Bochnum, Germany; (M.G.)
| | - Stephen O’Connor
- Department of Biomedical Engineering, City, University of London, London WC1E 7HU, UK
| | - Christian Perings
- Department of Cardiology, Electrophysiology, Pneumology and Intensive Care Medicine, St. Marien-Hospital Luenen, Academic Hospital of the University Muenster, 44534 Lünen, Germany
| | - Thomas Lawo
- Department of Cardiology, Elisabeth Hospital Recklinghausen, 45661 Recklinghausen, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, 44789 Bochum, Germany (A.M.)
- Department of Molecular and Experimental Cardiology, Institut für Forschung und Lehre (IFL), Ruhr-University Bochum, 44791 Bochum, Germany
| | - Christoph Hanefeld
- Department of Cardiology, Katholische Kliniken Bochum of the Ruhr University Bochum, 44791 Bochnum, Germany; (M.G.)
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, 44789 Bochum, Germany (A.M.)
- Department of Cardiology, Katholische Kliniken Bochum of the Ruhr University Bochum, 44791 Bochnum, Germany; (M.G.)
| | - Axel Kloppe
- Department of Cardiology and Angiology, Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, 45886 Gelsenkirchen, Germany
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, 44789 Bochum, Germany (A.M.)
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21
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Heo GY, Park JT, Kim HJ, Kim KW, Kwon YU, Kim SH, Kim GO, Han SH, Yoo TH, Kang SW, Kim HW. Adequacy of Dialysis and Incidence of Atrial Fibrillation in Patients Undergoing Hemodialysis. Circ Cardiovasc Qual Outcomes 2024; 17:e010595. [PMID: 38873761 DOI: 10.1161/circoutcomes.123.010595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/17/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) can lead to stroke, heart failure, and mortality and has a greater prevalence in dialysis patients than in the general population. Several studies have suggested that uremic toxins may contribute to the development of AF. However, the association between dialysis adequacy and incident AF has not been well established. METHODS In this retrospective nationwide cohort study, we analyzed data from the Korean National Periodic Hemodialysis Quality Assessment from 2013 to 2015 of patients who received outpatient maintenance hemodialysis 3× a week. The main exposure was single pooled Kt/V (spKt/V), which is the dialysis adequacy index, and the primary outcome was the development of AF. For the primary analysis, patients were categorized into quartiles according to baseline spKt/V. The lowest quartile, representing the lowest adequacy, was used as the reference group. Fine-Gray subdistribution hazard models were used, treating all-cause mortality as a competing risk. RESULTS Of 25 173 patients, the mean age was 60 (51-69) years, and 14 772 (58.7%) were men. During a median follow-up of 5.7 years, incident AF occurred in a total of 3883 (15.4%) patients. Participants with a higher spKt/V tended to have lower AF incidence. In survival analysis, a graded association was observed between the risk of incident AF and spKt/V quartiles: subdistribution hazard ratios and 95% CIs for the second, third, and the highest quartile compared with the lowest quartile were 0.90 (95% CI, 0.82-0.98), 0.84 (95% CI, 0.77-0.93), and 0.79 (95% CI, 0.72-0.88), respectively. CONCLUSIONS This nationwide cohort study showed that a higher spKt/V is associated with a reduced risk of incident AF. These findings suggests that reducing uremic toxin burden through enhanced dialysis clearance may be associated with a lower risk of AF development in patients undergoing maintenance hemodialysis.
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Affiliation(s)
- Ga Young Heo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Jung Tak Park
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Hyo Jeong Kim
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea (H.J.K.)
| | - Kyung Won Kim
- Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (K.W.K.)
| | - Yong Uk Kwon
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, South Korea (Y.U.K.)
| | - Soo Hyun Kim
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, South Korea (S.H.K.)
| | - Gui Ok Kim
- Quality Assessment Management Division, Health Insurance Review and Assessment Service, Wonju, South Korea (G.O.K.)
| | - Seung Hyeok Han
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Shin-Wook Kang
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
| | - Hyung Woo Kim
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea (G.Y.H., J.T.P., S.H.H., T.-H.Y., S.-W.K., H.W.K.)
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea (H.W.K.)
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22
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Sasaki S, Fujisaki K, Nishimura M, Nakano T, Abe M, Hanafusa N, Joki N. Association Between Disturbed Serum Phosphorus Levels and QT Interval Prolongation. Kidney Int Rep 2024; 9:1792-1801. [PMID: 38899225 PMCID: PMC11184388 DOI: 10.1016/j.ekir.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 02/09/2024] [Accepted: 03/04/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction QT interval prolongation is a risk factor for fatal arrhythmias and other cardiovascular complications. QT interval prolongation in patients on hemodialysis (HD) is not well understood. Hypocalcemia is a suspected, but poorly verified etiology in these patients, and the association between serum phosphorus levels and QT interval prolongation is unknown. We sought to determine the prevalence of QT interval prolongation in patients on HD and to verify the association between predialysis serum calcium (Ca) and phosphate (P) levels and QT interval prolongation. Methods A cross-sectional study was conducted on adult patients on maintenance HD who were enrolled in the Japanese Society for Dialysis Therapy and Renal Data Registry 2019. After assessing patient characteristics, linear regression analysis was performed with predialysis serum Ca and P levels as exposures and a rate-corrected QT (QTc) interval as the outcome. Results A total of 204,530 patients were analyzed with a mean QTc of 451.2 (standard deviation, 36.9) ms. After multivariable analysis, estimated change in QTc (coefficients; 95% confidence interval) per 1 mg/dl increase in serum Ca and P was -2.02 (-3.00 to -1.04) and 5.50 (3.92-7.09), respectively. In the restricted cubic spline curve, estimated change in QTc increased with lower values of serum Ca. The correlation between serum P and QTc showed a U-shaped curve. Conclusion Decreased serum Ca levels and decreased and increased serum P levels may be associated with QT interval prolongation in patients on maintenance HD.
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Affiliation(s)
- Sho Sasaki
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | | | | | - Toshiaki Nakano
- Department of Medical and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women`s Medical University, Tokyo, Japan
| | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
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23
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Soomro QH, Koplan BA, Costea AI, Roy-Chaudhury P, Tumlin JA, Kher V, Williamson DE, Pokhariyal S, McClure CK, Charytan DM. Arrhythmia and Time of Day in Maintenance Hemodialysis: Secondary Analysis of the Monitoring in Dialysis Study. Kidney Med 2024; 6:100799. [PMID: 38572395 PMCID: PMC10987926 DOI: 10.1016/j.xkme.2024.100799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
RATIONALE & OBJECTIVE The incidence of arrhythmia varies by time of day. How this affects individuals on maintenance dialysis is uncertain. Our objective was to quantify the relationship of arrhythmia with the time of day and timing of dialysis. STUDY DESIGN Secondary analysis of the Monitoring in Dialysis study, a multicenter prospective cohort study. SETTINGS & PARTICIPANTS Loop recorders were implanted for continuous cardiac monitoring in 66 participants on maintenance dialysis with a follow up of 6 months. EXPOSURE Time of day based on 6-hour intervals. OUTCOMES Event rates of clinically significant arrhythmia. ANALYTICAL APPROACH Negative binomial mixed effects regression models for repeated measures were used to evaluate data from the Monitoring in Dialysis study for differences in diurnal patterns of clinically significant arrhythmia among those with end-stage kidney disease with heart failure and end-stage kidney disease alone. We additionally analyzed rates according to presence of heart failure, time of dialysis shift, and dialysis versus nondialysis day. RESULTS Rates of clinically significant arrhythmia peaked between 12:00 AM and 5:59 AM and were more than 1.5-fold as frequent during this interval than the rest of the day. In contrast, variations in atrial fibrillation peaked between 6:00 AM and 11:59 AM, but variations across the day were qualitatively small. Clinically significant arrhythmia occurred at numerically higher rate in individuals with end-stage kidney disease and heart failure (5.9 events/mo; 95% CI, 1.3-26.8) than those without heart failure (4.0 events/mo; 95% CI, 0.9-17.9). Although differences in overall rate were not significant, their periodicity was significantly different (P < 0.001), with a peak between 12:00 AM and 6:00 AM with kidney failure alone and between 6:00 AM and 11:59 AM in those with heart failure. Although the overall clinically significant arrhythmia rate was similar in morning compared with evening dialysis shifts (P = 0.43), their periodicity differed with a peak between 12:00 AM and 5:59 AM in those with AM dialysis and a later peak between 6:00 AM and 11:59 AM in those with PM shifts. LIMITATIONS Post hoc analysis, unable to account for unmeasured confounders. CONCLUSION Clinically significant arrhythmias showed strong diurnal patterns with a maximal peak between 12:00 AM and 5:59 AM and noon. Although overall arrhythmia rates were similar, the peak rate occurred overnight in individuals without heart failure and during the morning in individuals with heart failure. Further exploration of the influence of circadian rhythm on arrhythmia in the setting of hemodialysis is needed.
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Affiliation(s)
- Qandeel H. Soomro
- Nephrology Division, Department of Medicine, NYU Langone Medical Center, New York, New York
| | | | | | - Prabir Roy-Chaudhury
- University of North Carolina Kidney Center, Chapel Hill, North Carolina
- WG (Bill) Hefner VA Medical Center, Salisbury, North Carolina
| | - James A. Tumlin
- Georgia Nephrology Clinical Research Institute, Atlanta, Georgia
| | - Vijay Kher
- Fortis Escorts Kidney & Urology Institute, Fortis Escorts Hospital, New Delhi, India
| | | | | | | | - David M. Charytan
- Nephrology Division, Department of Medicine, NYU Langone Medical Center, New York, New York
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24
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Pun PH. Listening to the Rhythm of Arrhythmias Among Patients Maintained on Hemodialysis. Kidney Med 2024; 6:100803. [PMID: 38572396 PMCID: PMC10987898 DOI: 10.1016/j.xkme.2024.100803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Affiliation(s)
- Patrick H. Pun
- Address for Correspondence: Patrick H. Pun, MD, MHS, Duke Clinical Research Institute, PO Box 17969, Durham, North Carolina 27715.
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25
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Soomro QH, Charytan DM. New Insights on Cardiac Arrhythmias in Patients With Kidney Disease. Semin Nephrol 2024; 44:151518. [PMID: 38772780 DOI: 10.1016/j.semnephrol.2024.151518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
The risk of arrhythmia and its management become increasingly complex as kidney disease progresses. This presents a multifaceted clinical challenge. Our discussion addresses these specific challenges relevant to patients as their kidney disease advances. We highlight numerous opportunities for enhancing the current standard of care within this realm. Additionally, this review delves into research concerning early detection, prevention, diagnosis, and treatment of various arrhythmias spanning the spectrum of kidney disease.
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26
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Wing SL, Mavrakanas TA, Harel Z. Oral Anticoagulation Use in Individuals With Atrial Fibrillation and Chronic Kidney Disease: A Review. Semin Nephrol 2024; 44:151517. [PMID: 38744617 DOI: 10.1016/j.semnephrol.2024.151517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Atrial fibrillation (AF) is highly prevalent in patients with chronic kidney disease (CKD). It is associated with an increased risk of stroke, which increases as kidney function declines. In the general population and in those with a moderate degree of CKD (creatinine clearance 30-50 mL/min), the use of oral anticoagulation to decrease the risk of stroke has been the standard of care based on a favorable risk-benefit profile that had been established in seminal randomized controlled trials. However, evidence regarding the use of oral anticoagulants for stroke prevention is less clear in patients with severe CKD (creatinine clearance <30 mL/min) and those receiving maintenance dialysis, as these individuals were excluded from such large randomized controlled trials. Nevertheless, the direct oral anticoagulants have invariably usurped vitamin K antagonists as the preferred choice for oral anticoagulation among patients with AF across all strata of CKD based on their well-defined safety and efficacy and multiple pharmacokinetic benefits (e.g., less drug-drug interactions). This review summarizes the current literature on the role of oral anticoagulation in the management of AF among patients with CKD and highlights current deficiencies in the evidence base and how to overcome them.
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Affiliation(s)
- Sara L Wing
- Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Thomas A Mavrakanas
- Division of Nephrology, Department of Medicine, McGill University Health Centre and Research Institute, Montreal, Canada
| | - Ziv Harel
- Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada.
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27
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP, American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 PMCID: PMC12146881 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 848] [Impact Index Per Article: 848.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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28
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Lin Y, Chao TF, Tsai ML, Tseng CJ, Wang TH, Chang CH, Lin YS, Yang NI, Chu PH, Hung MJ, Wu VCC, Chen TH. Cardiovascular and renal outcomes in patients with atrial fibrillation and stage 4-5 chronic kidney disease receiving direct oral anticoagulants: a multicenter retrospective cohort study. J Thromb Thrombolysis 2024; 57:89-100. [PMID: 37605063 DOI: 10.1007/s11239-023-02885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 08/23/2023]
Abstract
The role of direct oral anticoagulants (DOAC) in patients with atrial fibrillation (AF) and stage 4-5 chronic kidney disease (CKD) is controversial. Electronic medical records from 2012 to 2021 were retrieved for patients with AF and stage 4-5 CKD receiving oral anticoagulants. Patients were separated into those receiving DOACs (dabigatran, rivaroxaban, apixaban, or edoxaban) or vitamin K antagonists (VKA). Primary outcomes included ischemic stroke (IS), systemic thrombosis (SE), major bleeding, gastrointestinal bleeding, hemorrhagic stroke, acute myocardial infarction, cardiovascular death, and all-cause death. Renal outcomes included eGFR declines, creatinine doubling, progression to dialysis, and major adverse kidney events (MAKE). The primary analysis was until the end of follow up and the results at 1-year and 2-year of follow ups were also assessed. 2,382 patients (DOAC = 1,047, VKA = 1,335) between 2012 and 2021 with AF and stage 4-5 CKD were identified. The mean follow-up period was 2.3 ± 2.1 years in DOCAs and 2.6 ± 2.3 years in VKA respectively. At the end of follow up, the DOAC patients had significantly decreased SE (subdistribution hazard ratio [SHR] = 0.50, 95% confidence interval [CI] = 0.34-0.73), composite of IS/SE (SHR = 0.78, 95% CI = 0.62-0.98), major bleeding (HR = 0.77, 95% CI = 0.66-0.90), hemorrhagic stroke (HR = 0.52, 95% CI = 0.36-0.76), and composite of bleeding events (SHR = 0.80, 95% CI = 0.69-0.92) compared with VKA patients. The IS efficacy outcome revealed neutral between DOAC and VKA patients (HR = 1.05, 95% CI = 0.79-1.39). In addition, DOAC patients had significantly decreased rates of eGFR decline > 50% (SHR = 0.75, 95% CI = 0.64-0.87), creatinine doubling (SHR = 0.80, 95% CI = 0.67-0.95), and MAKE (SHR = 0.81, 95% CI = 0.71-0.93). In patients with AF and stage 4-5 CKD, use of DOAC was associated with decreased rates of a composite of ischemic stroke/systemic embolism, a composite of bleeding events, and renal events compared to VKA. Efficacy and safety benefits associated with apixaban at standard doses were consistent throughout follow-up.
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Affiliation(s)
- Yuan Lin
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Lung Tsai
- Division of Cardiology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Chin-Ju Tseng
- Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Te-Hsiung Wang
- Department of Emergency Medicine, Medical Research Institute, Kitano Hospital, Tazuke Kofukai, Osaka, Japan
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Chih-Hsiang Chang
- Department of Nephrology, Kidney Research Center, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yu-Sheng Lin
- Chang Gung University College of Medicine, Tao-Yuan, Taiwan
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ning-I Yang
- Department of Cardiology, Keelung Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan
| | - Ming-Jui Hung
- Department of Cardiology, Keelung Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, Taiwan
| | - Victor Chien-Chia Wu
- Division of Cardiology, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan.
| | - Tien-Hsing Chen
- Department of Cardiology, Keelung Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, Taiwan.
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.
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29
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Dilaver RG, Ikizler TA. Personalizing electrolytes in the dialysis prescription: what, why and how? Clin Kidney J 2024; 17:sfad210. [PMID: 38186873 PMCID: PMC10768751 DOI: 10.1093/ckj/sfad210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Indexed: 01/09/2024] Open
Abstract
Maintenance hemodialysis patients suffer from multiple comorbidities and treatment-related complications. A personalized approach to hemodialysis prescription could reduce some of these burdens by preventing complications such as excessive changes in blood pressure, arrhythmias, post-dialysis fatigue and decreased quality of life. A patient-centered approach to dialysate electrolyte concentrations represents one such opportunity. In addition to modifications in dialysate electrolyte concentrations, consideration of individual factors such as patients' serum concentrations, medication profiles, nutritional status and comorbidities is critical to tailoring hemodialysis prescriptions to optimize patient outcomes. The development of personalized dialysis treatment depends on the collection of comprehensive patient data, advances in technology, resource allocation and patient involvement in decision-making. This review discusses how the treatment of maintenance hemodialysis patients could benefit from individualized changes in certain dialysis fluid components.
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Affiliation(s)
- R Gulsah Dilaver
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - T Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Pun PH, Santacatterina M, Ways J, Redd C, Al-Khatib SM, Smyth-Melsky J, Chinitz L, Charytan DM. Point-of-Care Chemistry-Guided Dialysate Adjustment to Reduce Arrhythmias: A Pilot Trial. Kidney Int Rep 2023; 8:2385-2394. [PMID: 38025214 PMCID: PMC10658265 DOI: 10.1016/j.ekir.2023.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Excessive dialytic potassium (K) and acid removal are risk factors for arrhythmias; however, treatment-to-treatment dialysate modification is rarely performed. We conducted a multicenter, pilot randomized study to test the safety, feasibility, and efficacy of 4 point-of-care (POC) chemistry-guided protocols to adjust dialysate K and bicarbonate (HCO3) in outpatient hemodialysis (HD) clinics. Methods Participants received implantable cardiac loop monitors and crossed over to four 4-week periods with adjustment of dialysate K or HCO3 at each treatment according to pre-HD POC values: (i) K-removal minimization, (ii) K-removal maximization, (iii) Acidosis avoidance, and (iv) Alkalosis avoidance. The primary end point was percentage of treatments adhering to the intervention algorithm. Secondary endpoints included pre-HD K and HCO variability, adverse events, and rates of clinically significant arrhythmias (CSAs). Results Nineteen subjects were enrolled in the study. HD staff completed POC testing and correctly adjusted the dialysate in 604 of 708 (85%) of available HD treatments. There was 1 K ≤3, 29 HCO3 <20 and 2 HCO3 >32 mEq/l and no serious adverse events related to study interventions. Although there were no significant differences between POC results and conventional laboratory measures drawn concurrently, intertreatment K and HCO3 variability was high. There were 45 CSA events; most were transient atrial fibrillation (AF), with numerically fewer events during the alkalosis avoidance period (8) and K-removal maximization period (3) compared to other intervention periods (17). There were no significant differences in CSA duration among interventions. Conclusion Algorithm-guided K/HCO3 adjustment based on POC testing is feasible. The variability of intertreatment K and HCO3 suggests that a POC-laboratory-guided algorithm could markedly alter dialysate-serum chemistry gradients. Definitive end point-powered trials should be considered.
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Affiliation(s)
- Patrick H. Pun
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michele Santacatterina
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Javaughn Ways
- Division of Nephrology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Cynthia Redd
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sana M. Al-Khatib
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jane Smyth-Melsky
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Larry Chinitz
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - David M. Charytan
- Division of Nephrology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
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Law MM, Tan SJ, Wong MC, Toussaint ND. Atrial Fibrillation in Kidney Failure: Challenges in Risk Assessment and Anticoagulation Management. Kidney Med 2023; 5:100690. [PMID: 37547561 PMCID: PMC10403723 DOI: 10.1016/j.xkme.2023.100690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Management of atrial fibrillation (AF) is a clinical conundrum in people with kidney failure. Stroke risk is disproportionately high, but clinicians have a limited armamentarium to improve outcomes in this population in whom there is a concurrently high bleeding risk. Direct oral anticoagulants may have a superior benefit-risk profile compared with vitamin K antagonists in people on hemodialysis. Although research has predominantly focused on identifying a safe and effective oral anticoagulation option to reduce stroke risk in people with kidney failure (and predominantly those on hemodialysis), it remains uncertain how clinicians discriminate between people who would derive net clinical benefit as opposed to net harm. The recommended CHA2DS2-VASc score cutoffs provide poor discriminatory value, and there is an urgent need to identify robust markers of thromboembolic risk in kidney failure. There is increasing data to challenge the prior dogma of risk equivalence across AF type, and the American Heart Association highlights moving beyond AF as a binary entity to consider the prognostic significance of AF burden. Implantable cardiac monitor studies reveal high rates and varied burden of subclinical and paroxysmal AF in people on hemodialysis. The association between AF burden and the proarrhythmic environment of hemodialysis with cyclical volume loading, offloading, and electrolyte changes is not well studied. We review the significance of AF burden as a contributor to thromboembolic risk, its potential as the missing link in risk assessment, and updated evidence for anticoagulation in people with kidney failure.
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Affiliation(s)
- Mandy M. Law
- Department of Nephrology, the Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Sven-Jean Tan
- Department of Nephrology, the Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Michael C.G. Wong
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Department of Cardiology, the Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nigel D. Toussaint
- Department of Nephrology, the Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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Floria M, Tanase DM. Bradyarrhythmias in patients with atrial fibrillation. Heart 2023; 109:1266-1268. [PMID: 37012041 DOI: 10.1136/heartjnl-2023-322498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Affiliation(s)
- Mariana Floria
- Internal Medicine, Emergency County Hospital Saint Spiridon, Iasi, Romania
- Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Daniela Maria Tanase
- Internal Medicine, Emergency County Hospital Saint Spiridon, Iasi, Romania
- Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
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Almuhana AH, Alkhwaiter LI, Alghamdi A, Alsaleem A, Almehrij A, Abdalla M, Al Sayyari AA. Association between Hypertension and Atrial Fibrillation in Patients on Hemodialysis. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:313-322. [PMID: 38345586 DOI: 10.4103/1319-2442.395447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
This study aimed to evaluate the prevalence and the association between hypertension (HTN) and atrial fibrillation (AF) in hemodialysis (HD) patients. A chart review-based, cross-sectional study was conducted on HD patients who had received HD for at least 6 months. Demographic, hemodynamic, and laboratory data were retrieved from the BestCare system, and the main outcomes were blood pressure before and after dialysis, and the presence of AF. Our sample consisted of 304 HD patients; 162 (53%) were male, and the mean age was 63 ± 18 years. Sixty-eight (20%) had AF, of whom 44 (64.7%) were male, with a mean age of 73 ± 12 years. The risk of AF increased by 0.4 [odds ratio: 1.04; 95% confidence interval (CI): 1.02-1.06; P <0.001] for every year of age. Almost the entire sample (66.45%, n = 202) was hypertensive, and those patients had a mean age of 64 ± 17 years, and nearly one-third had a body mass index in the obese category (28.7%, n = 58). In addition, with every increase in the Charlson comorbidity index score by two points, there was a 40% increased risk of developing HTN (OR: 2.47; 95% CI: 1.17-5.18; P = 0.017). The risk factors for the development of HTN and AF in HD patients were found to be increasing age for AF and female sex for HTN. The presence of HTN and diabetes increased the risk of developing AF seven-fold after HD.
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Affiliation(s)
- Alanoud Husain Almuhana
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Lolo Ibrahim Alkhwaiter
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abeer Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alreem Alsaleem
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Arwa Almehrij
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mubarak Abdalla
- Divsion of Nephrology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulla Ahmed Al Sayyari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Divsion of Nephrology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Endo D, Kinoshita T, Lee J, Machida Y, Nishida K, Sato Y, Yamamoto T, Tabata M. Left Atrial Appendage Closure During Coronary Bypass Surgery in Patients on Hemodialysis. Circ J 2023; 87:982-989. [PMID: 36928272 DOI: 10.1253/circj.cj-22-0573] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Patients with end-stage renal disease on hemodialysis (ESRD-HD) have a lifelong risk of atrial fibrillation-related stroke. We compared clinical outcomes in ESRD-HD patients undergoing coronary artery bypass grafting (CABG) with and without concomitant left atrial appendage (LAA) closure. METHODS AND RESULTS Of 2,783 consecutive patients undergoing isolated CABG between 2002 and 2020, 242 patients had ESRD-HD with sinus rhythm. The primary outcome was a composite of death and stroke. An inverse probability (IP)-weighted cohort was created based on the propensity score. The 2 IP-weighted groups had well-balanced baseline and surgical backgrounds, with an equivalent follow-up. Five-year stroke-free survival was significantly higher in patients with LAA closure (log-rank test, P=0.035). The adjusted hazard ratio of LAA closure for death and stroke was 0.43 (95% confidence interval [CI] 0.20-0.92; P=0.023). Competing risk analysis showed that LAA closure was significantly associated with a risk reduction of stroke (subhazard ratio 0.26; 95% CI 0.08-0.96; P=0.028). No significant difference was observed in adjusted risk ratios for reoperation for bleeding, new atrial fibrillation, 30-day mortality, and readmission for heart failure. CONCLUSIONS Concomitant LAA closure during CABG can reduce the risk of death and stroke in ESRD-HD patients with normal sinus rhythm.
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Affiliation(s)
- Daisuke Endo
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | - Takeshi Kinoshita
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | - Jiyoung Lee
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | - Yoichiro Machida
- Department of Cardiovascular Surgery, Toda Chuo General Hospital
| | - Kosuke Nishida
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | - Yuichiro Sato
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University School of Medicine Nerima Hospital
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
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Bolas T, Werner K, Alkenbrack S, Uribe MV, Wang M, Risko N. The economic value of personal protective equipment for healthcare workers. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002043. [PMID: 37347760 DOI: 10.1371/journal.pgph.0002043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 05/19/2023] [Indexed: 06/24/2023]
Abstract
In this paper, we examine the cost effectiveness of investment in personal protective equipment (PPE) for protecting health care workers (HCWs) against two infectious diseases: Ebola virus and methicillin-resistant Staphylococcus aureus (MRSA). This builds on similar work published for COVID-19 in 2020. We developed two separate decision-analytic models using a payer perspective to compare the costs and effects of multiple PPE use scenarios for protection of HCW against Ebola and MRSA. Bayesian multivariate sensitivity analyses were used to consider the uncertainty surrounding all key parameters for both diseases. We estimate the cost to provide adequate PPE for a HCW encounter with an Ebola patient is $13.04, which is associated with a 97% risk reduction in infections. The mean incremental cost-effectiveness ratio (ICER) is $3.98 per disability-adjusted life year (DALY) averted. Because of lowered infection and disability rates, this investment is estimated to save $132.27 in averted health systems costs, a financial ROI of 1,014%. For MRSA, the cost of adequate PPE for one HCW encounter is $0.88, which is associated with a 53% risk reduction in infections. The mean ICER is $362.14 per DALY averted. This investment is estimated to save $20.18 in averted health systems costs, a financial ROI of 2,294%. In terms of total health savings per death averted, investing in adequate PPE is the dominant strategy for Ebola and MRSA, suggesting that it is both more costly and less clinically optimal to not fully invest in PPE for these diseases. There are many compelling reasons to invest in PPE to protect HCWs. This analysis examines the economic case, building on previous evidence that protecting HCWs with PPE is cost-effective for COVD-19. Ebola and MRSA scenarios were selected to allow assessment of both endemic and epidemic infectious diseases. While PPE is cost-effective for both conditions, compared to our analysis for COVID-19, PPE is relatively more cost-effective for Ebola and relatively less so for MRSA. Further research is needed to assess shortfalls in the PPE supply chain identified during the COVID-19 pandemic to ensure an efficient and resilient supply in the face of future pandemics.
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Affiliation(s)
- Theodore Bolas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kalin Werner
- Institute for Health & Aging, University of California, San Francisco, San Francisco, California, United States of America
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Sarah Alkenbrack
- World Bank, Health, Nutrition and Population Global Practice, Washington DC, United States of America
| | - Manuela Villar Uribe
- World Bank, Health, Nutrition and Population Global Practice, Washington DC, United States of America
| | - Mengxiao Wang
- World Bank, Health, Nutrition and Population Global Practice, Washington DC, United States of America
| | - Nicholas Risko
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
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Fishbane S, Jadoul M, Dember L, Kovesdy CP, Al-Shurbaji A, Lisovskaja V, Sekar P, Katona B, Guzman N, Herzog C. Evaluation of the effect of sodium zirconium cyclosilicate on arrhythmia-related cardiovascular outcomes in patients receiving chronic haemodialysis with hyperkalaemia: protocol for the multicentre, randomised, controlled DIALIZE-Outcomes study. BMJ Open 2023; 13:e071309. [PMID: 37230521 PMCID: PMC10230973 DOI: 10.1136/bmjopen-2022-071309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/13/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Patients with kidney failure receiving chronic haemodialysis have elevated risk of arrhythmias potentially increasing the likelihood of sudden cardiac death, stroke and hospitalisation. The DIALIZE study (NCT03303521) demonstrated that sodium zirconium cyclosilicate (SZC) was an efficacious and well-tolerated treatment for predialysis hyperkalaemia in patients undergoing haemodialysis. The DIALIZE-Outcomes study evaluates the effect of SZC on sudden cardiac death and arrhythmia-related cardiovascular outcomes in patients receiving chronic haemodialysis with recurrent hyperkalaemia. METHODS AND ANALYSIS International, multicentre, randomised, double-blind, placebo-controlled study conducted at 357 study sites across 25 countries. Adults (≥18 years) receiving chronic haemodialysis three times per week with recurrent predialysis serum potassium (K+) ≥5.5 mmol/L post long interdialytic interval (LIDI) are eligible. Patients (~2800) will be randomised 1:1 to SZC or placebo, starting at 5 g orally once daily on non-dialysis days and titrated weekly in 5 g increments (maximum 15 g) to target predialysis serum K+ 4.0-5.0 mmol/L post LIDI. The primary objective is to evaluate efficacy of SZC versus placebo in reducing occurrence of the primary composite endpoint of sudden cardiac death, stroke or arrhythmia-related hospitalisation, intervention or emergency department visit. Secondary endpoints include efficacy of SZC versus placebo in maintaining normokalaemia (serum K+ 4.0-5.5 mmol/L post LIDI) at the 12-month visit, preventing severe hyperkalaemia (serum K+ ≥6.5 mmol/L post LIDI) at the 12-month visit and reducing the incidence of individual cardiovascular outcomes. Safety of SZC will be evaluated. The study is event driven, with participants remaining in the study until 770 primary endpoint events have occurred. Average time in the study is expected to be ~25 months. ETHICS AND DISSEMINATION Approval was obtained from the relevant institutional review board/independent ethics committee from each participating site (approving bodies in supplementary information). The results will be submitted to a peer-reviewed journal. TRIAL REGISTRATION NUMBERS EudraCT 2020-005561-14 and clinicaltrials.gov identifier NCT04847232.
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Affiliation(s)
- Steven Fishbane
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Michel Jadoul
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laura Dember
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Vera Lisovskaja
- BioPharmaceuticals R&D, AstraZeneca Sweden, Gothenburg, Sweden
| | - Priya Sekar
- BioPharmaceuticals R&D, AstraZeneca US, Gaithersburg, Maryland, USA
| | - Brian Katona
- BioPharmaceuticals R&D, AstraZeneca US, Gaithersburg, Maryland, USA
| | - Nicolas Guzman
- BioPharmaceuticals R&D, AstraZeneca US, Gaithersburg, Maryland, USA
| | - Charles Herzog
- Division of Cardiology, Hennepin Healthcare, Minneapolis, Minnesota, USA
- Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Canaud B, Kooman J, Davenport A, Campo D, Carreel E, Morena-Carrere M, Cristol JP. Digital health technology to support care and improve outcomes of chronic kidney disease patients: as a case illustration, the Withings toolkit health sensing tools. FRONTIERS IN NEPHROLOGY 2023; 3:1148565. [PMID: 37675376 PMCID: PMC10479582 DOI: 10.3389/fneph.2023.1148565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/07/2023] [Indexed: 09/08/2023]
Abstract
Cardiovascular disease (CVD) is a major burden in dialysis-dependent chronic kidney disease (CKD5D) patients. Several factors contribute to this vulnerability including traditional risk factors such as age, gender, life style and comorbidities, and non-traditional ones as part of dialysis-induced systemic stress. In this context, it appears of utmost importance to bring a closer attention to CVD monitoring in caring for CKD5D patients to ensure early and appropriate intervention for improving their outcomes. Interestingly, new home-used, self-operated, connected medical devices offer convenient and new tools for monitoring in a fully automated and ambulatory mode CKD5D patients during the interdialytic period. Sensoring devices are installed with WiFi or Bluetooth. Some devices are also available in a cellular version such as the Withings Remote Patient Monitoring (RPM) solution. These devices analyze the data and upload the results to Withings HDS (Hybrid data security) platform servers. Data visualization can be viewed by the patient using the Withings Health Mate application on a smartphone, or with a web interface. Health Care Professionals (HCP) can also visualize patient data via the Withings web-based RPM interface. In this narrative essay, we analyze the clinical potential of pervasive wearable sensors for monitoring ambulatory dialysis patients and provide an assessment of such toolkit digital medical health devices currently available on the market. These devices offer a fully automated, unobtrusive and remote monitoring of main vital functions in ambulatory subjects. These unique features provide a multidimensional assessment of ambulatory CKD5D patients covering most physiologic functionalities, detecting unexpected disorders (i.e., volume overload, arrhythmias, sleep disorders) and allowing physicians to judge patient's response to treatment and recommendations. In the future, the wider availability of such pervasive health sensing and digital technology to monitor patients at an affordable cost price will improve the personalized management of CKD5D patients, so potentially resulting in improvements in patient quality of life and survival.
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Affiliation(s)
- Bernard Canaud
- Montpellier University, School of Medicine, Montpellier, France
- Global Medical Office, Fresenius Medical Care (FMC), Fresnes, France
| | - Jeroen Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, University College, London, United Kingdom
| | | | | | - Marion Morena-Carrere
- PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Biochemistry and Hormonology, University Hospital Center of Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Biochemistry and Hormonology, University Hospital Center of Montpellier, Montpellier, France
- AIDER-Santé, Ch. Mion Foundation, Montpellier, France
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Mc Causland FR, Hsu JY, Himmelfarb J, Ikizler TA, Raj DS, Mehrotra R, Waikar SS, Kimmel PL, Kliger AS, Dember LM, Charytan DM. Effects of Spironolactone on Arrhythmias in Hemodialysis Patients: Secondary Results of the SPin-D Randomized Controlled Trial. KIDNEY360 2023; 4:e486-e495. [PMID: 36763641 PMCID: PMC10278797 DOI: 10.34067/kid.0000000000000067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/21/2022] [Indexed: 02/12/2023]
Abstract
Key Points The effects of spironolactone on arrhythmia in patients receiving maintenance hemodialysis are unclear. In these post hoc analyses, spironolactone resulted in a higher frequency of bradycardia and conduction blocks, compared with placebo. Close monitoring may be warranted for patients on maintenance hemodialysis receiving MRAs, while definitive trial results are awaited. Background Patients receiving maintenance hemodialysis (HD) have a high incidence of cardiovascular events, including arrhythmia and sudden death. Spironolactone reduces the risk of cardiovascular events and sudden death in patients with heart failure, but the effects of spironolactone on arrhythmic events in patients treated with maintenance HD are unclear. Methods The Safety and Cardiovascular Efficacy of Spironolactone in Dialysis-Dependent ESRD (SPin-D) trial was a 36-week randomized, placebo-controlled, double-blind trial comparing three different doses of spironolactone with placebo in maintenance HD patients. We performed a post hoc analysis in a subset (n =57) who underwent extended electrocardiographic monitoring using a wearable device at baseline and follow-up. Generalized estimating equations models were fit to determine the associations of spironolactone (individual doses and combined) versus placebo on the incidence rate of predefined categories of arrhythmic events. Results The average age of participants was 55±12 years, 61% were male, and 77% were Black. The overall proportion of patients with at least one arrhythmia event was 43% (15/35) at baseline and 81% (43/53) at the end of follow-up. At the end of follow-up, the rate of bradycardic events or conduction blocks was higher in the combined spironolactone group, compared with placebo (82.4 versus 38.7 events/100 patient-days; P <0.001). Similar findings were noted in adjusted models, but did not meet statistical significance (adjusted rate ratio of 2.04; 95% confidence interval 0.83–5.05). Conclusions In a 36-week trial of patients receiving maintenance HD, a higher frequency of bradycardia and conduction blocks was observed among those treated with spironolactone treatment compared with placebo. Larger studies are required to investigate the longer-term effects of spironolactone on cardiac conduction in patients receiving HD.
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Affiliation(s)
- Finnian R Mc Causland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jesse Y Hsu
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan Himmelfarb
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Talat Alp Ikizler
- Division of Nephrology and Hypertension, Department of Medicine, and Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dominic S Raj
- Division of Renal Diseases and Hypertension, George Washington University School of Medicine, Washington, DC
| | - Rajnish Mehrotra
- Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | - Sushrut S Waikar
- Section of Nephrology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Paul L Kimmel
- National Institute of Diabetes Digestive and Kidney Diseases, Bethesda, Maryland
| | - Alan S Kliger
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Laura M Dember
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David M Charytan
- Nephrology Division, Department of Medicine, New York University Grossman School of Medicine, New York, New York
- NYU Langone Health, New York, New York
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 2299] [Impact Index Per Article: 1149.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Hu A, Liu S, Montez-Rath ME, Khairallah P, Niu J, Turakhia MP, Chang TI, Winkelmayer WC. Associations of Serum and Dialysate Potassium Concentrations With Incident Atrial Fibrillation in a Cohort Study of Older US Persons Initiating Hemodialysis for Kidney Failure. Kidney Int Rep 2023; 8:305-316. [PMID: 36815107 PMCID: PMC9939356 DOI: 10.1016/j.ekir.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/27/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Atrial fibrillation (AF) disproportionally affects persons on maintenance hemodialysis (HD). Associations of serum and dialysate potassium concentrations [K+] with AF incidence are poorly understood. Methods We conducted a cohort study using Medicare claims merged with clinical data from a dialysis provider to determine whether serum-[K+] and/or dialysate-[K+] independently associated with AF incidence. Persons insured by fee-for-service Medicare aged ≥67 years at dialysis initiation and free from diagnosed AF prior to day 120 of dialysis were eligible. Serum-[K+] and dialysate-[K+] were assessed in 30-day intervals and patients were followed-up with for AF incidence in subsequent 30-day intervals. Results During 2006 to 2011, 15,190 persons (mean age = 76.3 years) initiating HD had no prior AF diagnosis. Mean serum-[K+] was 4.5 mEq/l; dialysate-[K+] was 3 mEq/l in 34% and 2 mEq/l in 52% of patients. Followed-up over 21,907 person-years, 2869 persons had incident AF (incidence/100 person-years, 13.1 [95% confidence interval [CI], 12.6-13.6]). The multivariable-adjusted association of serum-[K+] with incident AF was J-shaped as follows: relative to a serum-[K+] of 4.5 mEq/l, lower serum-[K+] associated with increased AF risk, whereas confidence bands for higher serum-[K+] indicated no association. Dialysis against a dialysate-[K+] of 3 mEq/l versus 2 mEq/l independently associated with a 14% (95% CI, 5%-24%) lower incidence of AF. No effect modification between serum-[K+] and dialysate-[K+] was detected (P = 0.34). Conclusion Lower serum-[K+] was independently associated with incident AF whereas elevated serum-[K+] was not. The findings support adoption of dialysate solutions with a dialysate-[K+] of 3 mEq/l, regardless of patients' serum-[K+], and elimination of lower dialysate-[K+] solutions from practice. Clinical trials randomizing patients to different dialysate-[K+] are warranted to establish causality.
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Affiliation(s)
- Austin Hu
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sai Liu
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Maria E. Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Pascale Khairallah
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jingbo Niu
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Mintu P. Turakhia
- Cardiovascular Division, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Tara I. Chang
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Wolfgang C. Winkelmayer
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Stauss M, Htay H, Kooman JP, Lindsay T, Woywodt A. Wearables in Nephrology: Fanciful Gadgetry or Prêt-à-Porter? SENSORS (BASEL, SWITZERLAND) 2023; 23:1361. [PMID: 36772401 PMCID: PMC9919296 DOI: 10.3390/s23031361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Telemedicine and digitalised healthcare have recently seen exponential growth, led, in part, by increasing efforts to improve patient flexibility and autonomy, as well as drivers from financial austerity and concerns over climate change. Nephrology is no exception, and daily innovations are underway to provide digitalised alternatives to current models of healthcare provision. Wearable technology already exists commercially, and advances in nanotechnology and miniaturisation mean interest is also garnering clinically. Here, we outline the current existing wearable technology pertaining to the diagnosis and monitoring of patients with a spectrum of kidney disease, give an overview of wearable dialysis technology, and explore wearables that do not yet exist but would be of great interest. Finally, we discuss challenges and potential pitfalls with utilising wearable technology and the factors associated with successful implementation.
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Affiliation(s)
- Madelena Stauss
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Jeroen P. Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Thomas Lindsay
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
| | - Alexander Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK
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Edwards JC, Mosman A, Hauptman PJ, Lee T, Philipneri M, Farahmand F, Yn L, Brandon M, Buchanan PM. Arrhythmia in chronic hemodialysis as a function of predialysis electrolytes and interdialytic interval. Hemodial Int 2023; 27:45-54. [PMID: 36411729 DOI: 10.1111/hdi.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION People with end-stage renal disease on hemodialysis are at increased risk for death due to arrhythmia associated with the prolonged interdialytic interval that typically spans the weekend, with bradycardia being the arrhythmia most closely associated with sudden death. In this prospective observational study we assessed whether predialysis fluid and electrolytes values including hyperkalemia are risk factors for the arrhythmias associated with the prolonged interdialytic interval. METHODS Sixty patients on hemodialysis with a history of hyperkalemia underwent cardiac monitoring for 1 week. Arrhythmia frequency, average QTc interval, and average root mean square of successive differences (rMSSD) per 4-h period were reported. Predialysis electrolytes and electrocardiograms were collected prior to pre- and post-weekend dialysis sessions. Clinical variables were assessed for correlation with arrhythmias. FINDINGS Predialysis hyperkalemia occurred in 29 subjects and was more common at the post-weekend dialysis session. Bradycardia occurred in 11 subjects and increased before and during the post-weekend dialysis session, but was not correlated with any electrolyte or clinical parameter. Ventricular ectopy occurred in 50 subjects with diurnal variation unrelated to dialysis. Pre-dialysis prolonged QTc was common and not affected by interdialytic interval. Average QTc increased and rMSSD decreased during dialysis sessions and were not correlated with clinical parameters. DISCUSSION The results confirm that arrhythmias are prevalent in dialysis subjects with bradycardia particularly associated with the longer interdialytic interval; EKG markers of arrhythmia risk are increased during dialysis independent of interdialytic interval. Larger sample size and/or longer recording may be necessary to identify the clinical parameters responsible.
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Affiliation(s)
- John C Edwards
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Amy Mosman
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Paul J Hauptman
- Reno School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Taewoo Lee
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Marie Philipneri
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Firoozeh Farahmand
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Louis Yn
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Margaret Brandon
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Paula M Buchanan
- AHEAD Institute, Department of Health and Clinical Outcomes Research Saint Louis University, Saint Louis, Missouri, USA
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Zheng Z, Soomro QH, Charytan DM. Deep Learning Using Electrocardiograms in Patients on Maintenance Dialysis. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:61-68. [PMID: 36723284 DOI: 10.1053/j.akdh.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cardiovascular morbidity and mortality occur with an extraordinarily high incidence in the hemodialysis-dependent end-stage kidney disease population. There is a clear need to improve identification of those individuals at the highest risk of cardiovascular complications in order to better target them for preventative therapies. Twelve-lead electrocardiograms are ubiquitous and use inexpensive technology that can be administered with minimal inconvenience to patients and at a minimal burden to care providers. The embedded waveforms encode significant information on the cardiovascular structure and function that might be unlocked and used to identify at-risk individuals with the use of artificial intelligence techniques like deep learning. In this review, we discuss the experience with deep learning-based analysis of electrocardiograms to identify cardiovascular abnormalities or risk and the potential to extend this to the setting of dialysis-dependent end-stage kidney disease.
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Affiliation(s)
- Zhong Zheng
- Nephology Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Qandeel H Soomro
- Nephology Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - David M Charytan
- Nephology Division, Department of Medicine, New York University Grossman School of Medicine, New York, NY.
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Arrhythmia and Heart Rate Variability during Long Interdialytic Periods in Patients on Maintenance Hemodialysis: Prospective Observational Cohort Study. J Clin Med 2022; 12:jcm12010265. [PMID: 36615065 PMCID: PMC9820857 DOI: 10.3390/jcm12010265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Sudden cardiac death among hemodialysis patients is related to the hemodialysis schedule. Mortality is highest within 12 h before and after the first hemodialysis sessions of a week. We investigated the association of arrhythmia occurrence and heart rate variability (HRV) using an electrocardiogram (ECG) monitoring patch during the long interdialytic interval in hemodialysis patients. This was a prospective observational study with 55 participants on maintenance hemodialysis for at least six months. A patch-type ECG monitoring device was applied to record arrhythmia events and HRV during 72 h of a long interdialytic period. Forty-nine participants with sufficient ECG data out of 55 participants were suitable for the analysis. The incidence of supraventricular tachycardia and ventricular tachycardia did not significantly change over time. The square root of the mean squared differences of successive NN intervals (RMSSD), the proportion of adjacent NN intervals differing by >50 ms (pNN50), and high-frequency (HF) increased during the long interdialytic interval. The gap in RMSSD, pNN50, HF, and the low-frequency/high-frequency (LF/HF) ratio between patients with and without significant arrhythmias increased significantly over time during the long interdialytic interval. The daily changes in RMSSD, pNN50, HF, and the LF/HF ratio were more prominent in patients without significant arrhythmias than in those with significant arrhythmias. The electrolyte fluctuation between post-hemodialysis and subsequent pre-hemodialysis was not considered in this study. The study results suggest that the decreased autonomic response during interdialytic periods in dialysis patients is associated with poor cardiac arrhythmia events.
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Soomro QH, Bansal N, Winkelmayer WC, Koplan BA, Costea AI, Roy-Chaudhury P, Tumlin JA, Kher V, Williamson DE, Pokhariyal S, McClure CK, Charytan DM. Association of Bradycardia and Asystole Episodes with Dialytic Parameters: An Analysis of the Monitoring in Dialysis (MiD) Study. KIDNEY360 2022; 3:1871-1880. [PMID: 36514397 PMCID: PMC9717630 DOI: 10.34067/kid.0003142022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bradycardia and asystole events are common among patients treated with maintenance hemodialysis. However, triggers of these events in patients on maintenance hemodialysis (HD), particularly during the long interdialytic period when these events cluster, are uncertain. METHODS The Monitoring in Dialysis Study (MiD) enrolled 66 patients on maintenance HD who were implanted with loop recorders and followed for 6 months. We analyzed associations of predialysis laboratory values with clinically significant bradyarrhythmia or asystole (CSBA) during the 12 hours before an HD session. Associations with CSBA were analyzed with mixed-effect models. Adjusted negative binomial mixed-effect regression was used to estimate incidence rate ratios (IRR) for CSBA. We additionally evaluated associations of CSBA at any time during follow-up with time-averaged dialytic and laboratory parameters and associations of peridialytic parameters with occurrence of CSBA from the start of one HD session to the beginning of the next. RESULTS There were 551 CSBA that occurred in the last 12 hours of the interdialytic interval preceding 100 HD sessions in 12% of patients and 1475 CSBA events in 23% of patients overall. We did not identify significant associations between dialytic parameters or serum electrolytes and CSBA in the last 12 hours of the interdialytic interval in adjusted analyses. Median time-averaged ultrafiltration rate was significantly higher in individuals without CSBA (9.8 versus 8, P=0.04). Use of dialysate sodium concentrations ≤135 (versus 140) mEq/L was associated with a reduced risk of CSBA from the start of one session to the beginning of next. CONCLUSIONS Although a few factors had modest associations with CSBA in some analyses, we did not identify any robust associations of modifiable parameters with CSBA in the MiD Study. Further investigation is needed to understand the high rates of arrhythmia in the hemodialysis population.
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Affiliation(s)
- Qandeel H. Soomro
- Nephrology Division, Department of Medicine, NYU Langone Medical Center, New York, New York
| | - Nisha Bansal
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington
| | - Wolfgang C. Winkelmayer
- Section of Nephrology, Selzman Institute for Kidney Health, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Internal Medicine/Nephrology, Emory University, Atlanta, Georgia
| | | | | | - Prabir Roy-Chaudhury
- University of North Carolina Kidney Center, Chapel Hill, North Carolina
- WG (Bill) Hefner VA Medical Center, Salisbury, North Carolina
| | - James A. Tumlin
- Georgia Nephrology Clinical Research Institute, Atlanta, Georgia
| | - Vijay Kher
- Fortis Escorts Kidney and Urology Institute, Fortis Escorts Hospital, New Delhi, India
| | | | | | | | - David M. Charytan
- Nephrology Division, Department of Medicine, NYU Langone Medical Center, New York, New York
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Safabakhsh S, Al-Shaheen A, Swiggum E, Mielniczuk L, Tremblay-Gravel M, Laksman Z. Arrhythmic Sudden Cardiac Death in Heart Failure With Preserved Ejection Fraction: Mechanisms, Genetics, and Future Directions. CJC Open 2022; 4:959-969. [PMID: 36444369 PMCID: PMC9700220 DOI: 10.1016/j.cjco.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is an increasingly recognized disorder. Many clinical trials have failed to demonstrate benefit in patients with HFpEF but have recognized alarming rates of sudden cardiac death (SCD). Genetic testing has become standard in the workup of patients with otherwise unexplained cardiac arrest, but the genetic architecture of HFpEF, and the overlap of a genetic predisposition to HFpEF and arrhythmias, is poorly understood. An understanding of the genetics of HFpEF and related SCD has the potential to redefine and generate novel diagnostic, prognostic, and therapeutic tools. In this review, we examine recent pathophysiological and clinical advancements in our understanding of HFpEF, which reinforce the heterogeneity of the condition. We also discuss data describing SCD events in patients with HFpEF and review the current literature on genetic underpinnings of HFpEF. Mechanisms of arrhythmogenesis which may lead to SCD in this population are also explored. Lastly, we outline several areas of promise for experimentation and clinical trials that have the potential to further advance our understanding of and contribute to improved clinical care of this patient population.
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Affiliation(s)
- Sina Safabakhsh
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Elizabeth Swiggum
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Mielniczuk
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Zachary Laksman
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Lévy S, Steinbeck G, Santini L, Nabauer M, Penela D, Kantharia BK, Saksena S, Cappato R. Management of atrial fibrillation: two decades of progress - a scientific statement from the European Cardiac Arrhythmia Society. J Interv Card Electrophysiol 2022; 65:287-326. [PMID: 35419669 DOI: 10.1007/s10840-022-01195-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. The aim of this review was to evaluate the progress made in the management of AF over the two last decades. RESULTS Clinical classification of AF is usually based on the presence of symptoms, the duration of AF episodes and their possible recurrence over time, although incidental diagnosis is not uncommon. The majority of patients with AF have associated cardiovascular diseases and more recently the recognition of modifiable risk factors both cardiovascular and non-cardiovascular which should be considered in its management. Among AF-related complications, stroke and transient ischaemic accidents (TIAs) carry considerable morbidity and mortality risk. The use of implantable devices such as pacemakers and defibrillators, wearable garments and subcutaneous cardiac monitors with recording capabilities has enabled to access the burden of "subclinical AF". The recent introduction of non-vitamin K antagonists has led to improve the prevention of stroke and peripheral embolism. Agents capable of reversing non-vitamin K antagonists have also become available in case of clinically relevant major bleeding. Transcatheter closure of left atrial appendage represents an option for patients unable to take oral anticoagulation. When treating patients with AF, clinicians need to select the most suitable strategy, i.e. control of heart rate and/or restoration and maintenance of sinus rhythm. The studies comparing these two strategies have not shown differences in terms of mortality. If an AF episode is poorly tolerated from a haemodynamic standpoint, electrical cardioversion is indicated. Otherwise, restoration of sinus rhythm can be obtained using intravenous pharmacological cardioversion and oral class I or class III antiarrhythmic is used to prevent recurrences. During the last two decades after its introduction in daily practice, catheter ablation has gained considerable escalation in popularity. Progress has also been made in AF associated with heart failure with reduced or preserved ejection fraction. CONCLUSIONS Significant progress has been made within the past 2 decades both in the pharmacological and non-pharmacological managements of this cardiac arrhythmia.
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Affiliation(s)
- Samuel Lévy
- Marseille School of Medicine, Aix-Marseille University, Marseille, France.
| | | | - Luca Santini
- Cardiology Division, G. B. Grassi Hospital, Via G. Passeroni 28, Ostia Lido, RM, Italy
| | - Michael Nabauer
- Klinikum Der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - Diego Penela
- Arrhythmia & Electrophysiology Center IRCCS Multimedica Via Milanese 300, Sesto San Giovanni, Milan, Italy
| | - Bharat K Kantharia
- Cardiovascular and Heart Rhythm Consultants, 30 West 60th Street, Suite 1U, New York, NY, 10023, USA
| | - Sanjeev Saksena
- Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Center IRCCS Multimedica Via Milanese 300, Sesto San Giovanni, Milan, Italy
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Sarnak MJ, Auguste BL, Brown E, Chang AR, Chertow GM, Hannan M, Herzog CA, Nadeau-Fredette AC, Tang WHW, Wang AYM, Weiner DE, Chan CT. Cardiovascular Effects of Home Dialysis Therapies: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e146-e164. [PMID: 35968722 DOI: 10.1161/cir.0000000000001088] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage kidney disease. Currently, thrice-weekly in-center hemodialysis for 3 to 5 hours per session is the most common therapy worldwide for patients with treated kidney failure. Outcomes with thrice-weekly in-center hemodialysis are poor. Emerging evidence supports the overarching hypothesis that a more physiological approach to administering dialysis therapy, including in the home through home hemodialysis or peritoneal dialysis, may lead to improvement in several cardiovascular risk factors and cardiovascular outcomes compared with thrice-weekly in-center hemodialysis. The Advancing American Kidney Health Initiative, which has a goal of increasing the use of home dialysis, is aligned with the American Heart Association's 2024 mission to champion a full and healthy life and health equity. We conclude that incorporation of interdisciplinary care models to increase the use of home dialysis therapies in an equitable manner will contribute to the ultimate goal of improving outcomes for patients with kidney failure and cardiovascular disease.
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Sološenko A, Paliakaitė B, Marozas V, Sörnmo L. Training Convolutional Neural Networks on Simulated Photoplethysmography Data: Application to Bradycardia and Tachycardia Detection. Front Physiol 2022; 13:928098. [PMID: 35923223 PMCID: PMC9339964 DOI: 10.3389/fphys.2022.928098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: To develop a method for detection of bradycardia and ventricular tachycardia using the photoplethysmogram (PPG). Approach: The detector is based on a dual-branch convolutional neural network (CNN), whose input is the scalograms of the continuous wavelet transform computed in 5-s segments. Training and validation of the CNN is accomplished using simulated PPG signals generated from RR interval series extracted from public ECG databases. Manually annotated real PPG signals from the PhysioNet/CinC 2015 Challenge Database are used for performance evaluation. The performance is compared to that of a pulse-based reference detector. Results: The sensitivity/specificity were found to be 98.1%/97.9 and 76.6%/96.8% for the CNN-based detector, respectively, whereas the corresponding results for the pulse-based detector were 94.7%/99.8 and 67.1%/93.8%, respectively. Significance: The proposed detector may be useful for continuous, long-term monitoring of bradycardia and tachycardia using wearable devices, e.g., wrist-worn devices, especially in situations where sensitivity is favored over specificity. The study demonstrates that simulated PPG signals are suitable for training and validation of a CNN.
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Affiliation(s)
- Andrius Sološenko
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
- *Correspondence: Andrius Sološenko ,
| | - Birutė Paliakaitė
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Vaidotas Marozas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
- Department of Electronics Engineering, Kaunas University of Technology, Kaunas, Lithuania
| | - Leif Sörnmo
- Department of Biomedical Engineering, Lund University, Lund, Sweden
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50
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Toapanta N, Comas J, León Román J, Ramos N, Azancot M, Bestard O, Tort J, Soler MJ. Mortality in elderly patients starting hemodialysis program. Semin Dial 2022. [PMID: 35817409 DOI: 10.1111/sdi.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/31/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of older patients over 80 years old with chronic kidney disease who start hemodialysis (HD) program has been increasing in the last decade. METHODS We aimed to identify risk factors for morbidity and mortality in patients older than 80 years with end-stage renal disease who started HD. We conducted a retrospective observational study of the Catalan Renal registry (RMRC). RESULTS A total of 2833 patients equal or older than 80 years (of 15,137) who started HD between 2002 and 2019 from the RMRC were included in the study. In this group, the first dialysis was performed through an arteriovenous fistula in 44%, percutaneous catheter in 28.2%, and tunneled catheter in 26.6%. Conventional dialysis was used in 65.7% and online HD in 34.3%. The most frequent cause of death was cardiac disease (21.8%), followed by social problems (20.4%) and infections (15.9%). Overall survival in older HD during the first year was 84% versus 91% in younger than 80 years (p < 0.001). Cox regression analysis identified the start of HD in the period 2002-2010, chronic obstructive pulmonary disease (COPD), and the onset of HD through vascular graft depicted as risk factors for first-year mortality after dialysis initiation in patients older than 80 years with end-stage renal disease who started HD. CONCLUSIONS In conclusion, patients older than 80 years who started HD program had higher mortality, especially those who presented exacerbation of kidney disease, those with COPD, and those who started with a vascular graft.
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Affiliation(s)
- Néstor Toapanta
- Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
| | - Jordi Comas
- Catalan Transplantation Organization, Barcelona, Spain
| | - Juan León Román
- Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
| | - Natalia Ramos
- Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
| | - María Azancot
- Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
| | - Oriol Bestard
- Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
| | - Jaume Tort
- Catalan Transplantation Organization, Barcelona, Spain
| | - María José Soler
- Nephrology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
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