Abstract: PUB137
Intradialytic Heartbeat Irregularities (IR) Predict Increased Mortality in Patients on Chronic Hemodialysis (HD)
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Sapoznikov, Dan, Hadassah University Medical Center, Jerusalem, Israel
- Dranitzki Elhalel, Michal, Hadassah University Medical Center, Jerusalem, Israel
- Backenroth, Rebecca, Hadassah University Medical Center, Jerusalem, Israel
- Rubinger, Dvora, Hadassah University Medical Center, Jerusalem, Israel
Background
The pressent study was undertaken to define the significance of asymptomatic IR during HD .
Methods
Beat to beat systolic blood pressure (SBP) and interbeat interval (IBI) were monitored duriing HD in 96 age-matched HD patients (Pt). IR were defined as ≧5 irregular beats over 10 min during HD. Hemodynamic variability indices were assessed using Finometer device and beatscope software.
Results
IR were detected im 29 Pt (IR(+)). The representative clinical data in IR (+) and in Pt with regular beats (IR (-) n=67) are listed in Table 1.There were no marked differences between groups regarding the proportion of diabetes (DM), hypertension, ischemic heart disease, history of previous arrhrythmia. biochemical measurements or anthypertensive medication. Kaplan Meier showed a significant decreased survival at 2 to 5, but not at 7 years (y) or later in IR (+) (Figure 1).
Conclusion
Intradialytic IR were more frequent in Pt with a background of smoking and LV systolic dysfunction. In these Pt, decreased SBP at the end of HD and increased variabilities of CO and TPR might have contributed to hemodynamic instability.
IR were associated with significntly enhanced mortality in HD.
Table 1.
| IR (-) (n=67, age 66±9 y) | IR (+) (n=29, age 65±12 y) | p | |
| Males/Females | 41/26 | 25/4 | 0.015 |
| DM (n/%) | 34/51 | 9/31 | NS |
| Hypertension (n/%) | 65/97 | 27/93 | NS |
| Ischemic heart disease (n/%) | 53/79 | 19/66 | NS |
| Smokers (n/%) | 26/39 | 19/66 | 0.025 |
| LV systolic dysfunction (n/%) | 18/28 | 13/52 | 0.031 |
| Δ SBP (mmHg)* # | 1±27 | -13±20 | 0.012 |
| IBI (msec) ** | 887 (249) | 834 (102)^ | 0.033 |
| sdCO (l/min)** | 0.46 (0.21) | 0.60 (0.18)^ | 0.001 |
| sdTPR (mmHG.s/ ml)** | 0.08 (0.06) | 0.11 (0.11)^ | 0.040 |
*mean ± SD ; # post dialysis SBP change; **Median (interquartile range); sd: standard deviation; CO: cardiac output; TPR:: total peripheral resistance; ^ determined in 16 IR (+).
Figure 1.