Abstract: TH-PO268
Asymptomatic Heartbeat Irregularities (AHbI) During Hemodialysis (HD) Are Associated with Decreased Short-Term Survival
Session Information
- Hemodialysis: Volume, Metabolic Complications, Clinical Outcomes
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Sapoznikov, Dan, Hadassah University Medical Center, Jerusalem, Israel
- Backenroth, Rebecca, Hadassah University Medical Center, Jerusalem, Israel
- Dranitzki Elhalel, Michal, Hadassah University Medical Center, Jerusalem, Israel
- Rubinger, Dvora, Hadassah University Medical Center, Jerusalem, Israel
Background
Intradialytic AHbI are not well defined and are of unknown significance.
Methods
Beat-to-beat systolic blood pressure (SBP) and interbeat interval (IBI) were monitored during regular HD sessions in 83 age-matched patients (Pt). AHbI were defined as ≥10 irregular beats on a 4hr recording. Hemodynamic variability indices were assessed using Finometer device and Beatscope software .
Results
AHbI were detected in 25 Pt (AHbI (+)). The representative clinical, laboratory and hemodynamic data in AHbI (+) and in Pt with regular beats (AHbI(-)) are listed in Table 1.There were no statistically significant differences between groups regarding the proportion of diabetes, hypertension, ischemic heart disease, SBP, intradialytic hypotension, PTH level or ultrafiltration rate. Kaplan-Meier analysis showed a significnant decreased survival at 2y in AHbI(+) (Figure 1).
Conclusion
1.Intradialytic AHbI are associated with cardiovascular risk factors and a higher plasma phosphate level, suggesting a link between mineral metabolism and heart disease.
2. In AHbI (+), diminished post HD plasma potassium change combined with decreased IBI and increased sdCO suggest a tendency to hemodynamic instability leading to higher mortality.
The nature and the long term effects of the AHbI remain to be further explored.
Table 1.
| AHbI (+) (n=25) Age 65±9 y | AHbI (-) (n=58) Age 66±10 y | p | |
| Male gender (n) | 22 | 34 | 0.009 |
| History of smoking (n,%) | 17 (68) | 19 (33) | 0.003 |
| Left ventricular systolic dysfunction (n,%) | 13 (54) | 13 (24) | 0.008 |
| Peripheral vascular disease (n,%) | 18 (72) | 28 (48) | 0.046 |
| Plasma calcium (mmo/L)* ^ | 2.25±0.17 | 2.27±0.17 | NS |
| Plasma phosphate (mmol/L)* ^ | 1.69±0.37 | 1.46±0.31 | 0.004 |
| Plasma potassium decrease after HD (mmol/L)^ | 1.24±0.56 | 1.54±0.61 | 0.039 |
| IBI (msec)** | 839 (122) | 891 (234) | 0.010 |
| sdDBP (mmHg)^^ ** | 3.7 (0.9) | 2.9 (1.3) | 0.003 |
| sdCO (L/min)^^ ** | 0.57 (0.25) | 0.44 (0.21) | 0.001 |
* Predialysis: ^mean±SD; **Median (interquartile range); ^^ sd (standard deviation) ; DBP: diastolic blood pressure; CO: cardiac output.
Figure 1.