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ASN / Education & Meetings / Kidney Week /
Abstract: SA-PO884

Intra-Dialytic Hypotension and Risk of Intra-Dialytic Cardiac Arrhythmia

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Roy-Chaudhury, Prabir, University of Arizona, Tucson, Arizona, United States
  • Tumlin, James A., NephroNet Clinical Trials Consortium, Atlanta, Georgia, United States
  • Charytan, David M., Brigham and Women's Hospital/Harvard Medical School, Brookline, Massachusetts, United States
Background

Patients with end-stage renal disease receiving hemodialysis (HD) are at high risk of adverse cardiac events, including arrhythmia and sudden cardiac death. Intra-dialytic hypotension (IDH) is a common complication of HD and is associated with development of reduced myocardial perfusion, but its association with cardiac arrhythmia is unclear.

Methods

The Monitoring in Dialysis (MiD) study used implantable loop recorders to detect and continuously record all electrocardiographic data from maintenance HD patients (n=66 from the United States and India) over a six-month period. Negative binomial mixed effects regression models were fit to determine the association of IDH (decline in SBP >20 mmHg from pre-dialysis SBP) with the subsequent development of clinically significant arrhythmia (CSA) during the corresponding HD sessions.

Results

Average age was 56 years; 70% were male; and 65% were from the US. IDH occurred in 48% of 4,761 HD sessions, while 1.3% of total sessions were complicated by development of at least one intra-dialytic CSA. Participants who experienced IDH (vs. those with SBP decline ≤0mmHg) had a 9-fold greater rate of developing an intra-dialytic CSA (IRR 9.4; 95%CI 3.0-29.4).

Conclusion

IDH is common in maintenance HD patients and is associated with a greater risk of developing intra-dialytic CSA. Future studies investigating the effect of interventions to minimize IDH may wish to incorporate arrhythmia as a clinically relevant end-point.

Funding

  • NIDDK Support – Medtronic