The Arrhythmias in End-Stage Renal Disease on Maintenance Haemodialysis: A Cross-Sectional Study
Main Article Content
Abstract
Background
Patients with end-stage renal disease (ESRD) on hemodialysis are at high risk for cardiovascular mortality, with arrhythmias being a major contributor. Data on this issue are scarce in low- and middle-income countries like Myanmar.
Objectives
This study aimed to determine the prevalence of arrhythmias in ESRD patients on maintenance hemodialysis, identify the predictors of these arrhythmias, and explore their clinical implications (short-term clinical outcomes).
Methods
We conducted a cross-sectional study of 140 adult ESRD patients on maintenance hemodialysis at a single center in Myanmar. All patients underwent 24-hour Holter ECG monitoring. We collected data on demographics, comorbidity, and laboratory and echocardiographic data. Logistic regression was used to identify predictors of arrhythmias.
Results
The mean age of the patients was 51.1 ± 14.6 years, and 70% were female. The overall prevalence of any arrhythmia was 65.7%. The most common arrhythmias were premature atrial contractions (36.4%) and premature ventricular contractions (31.4%). Atrial fibrillation was present in 7.1% of patients. In multivariate analysis, older age (OR 1.03, 95% CI 1.00–1.06), left ventricular hypertrophy (OR 3.12, 95% CI 1.44–6.76), abnormal left atrial volume index (OR 2.46, 95% CI 1.15–5.27), and higher creatinine levels (OR 1.17, 95% CI 1.00–1.38) were independent predictors of arrhythmias. Patients with arrhythmias had higher rates of hospitalization, emergency visits, and 3-month mortality.
Conclusion
Arrhythmias are highly prevalent in ESRD patients on hemodialysis in Myanmar and are associated with adverse clinical outcomes. Routine Holter monitoring could be a valuable tool for risk stratification in this high-risk population, particularly for those with echocardiographic evidence of LVH or abnormal LAVI
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. (1474-547X (Electronic)).
II. Johansen Kl Fau - Chertow GM, Chertow Gm Fau - Foley RN, Foley Rn Fau - Gilbertson DT, Gilbertson Dt Fau - Herzog CA, Herzog Ca Fau - Ishani A, Ishani A Fau - Israni AK, et al. US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States. (1523-6838 (Electronic)).
III. Green D, Roberts Pr Fau - New DI, New Di Fau - Kalra PA, Kalra PA. Sudden cardiac death in hemodialysis patients: an in-depth review. (1523-6838 (Electronic)).
IV. Wang X, Shapiro JI. Evolving concepts in the pathogenesis of uraemic cardiomyopathy. (1759-507X (Electronic)).
V. Genovesi S, Vincenti A Fau - Rossi E, Rossi E Fau - Pogliani D, Pogliani D Fau - Acquistapace I, Acquistapace I Fau - Stella A, Stella A Fau - Valsecchi MG, et al. Atrial fibrillation and morbidity and mortality in a cohort of long-term hemodialysis patients. (1523-6838 (Electronic)).
VI. Di Lullo L, House A Fau - Gorini A, Gorini A Fau - Santoboni A, Santoboni A Fau - Russo D, Russo D Fau - Ronco C, Ronco C. Chronic kidney disease and cardiovascular complications. (1573-7322 (Electronic)).
VII. Bello AK, Levin A, Tonelli M, Okpechi IG, Feehally J, Harris D, et al. Assessment of Global Kidney Health Care Status. (1538-3598 (Electronic)).
VIII. Taub CC, Stainback RF, Abraham T, Forsha D, Garcia- Sayan E, Hill JC, et al. Guidelines for the Standardization of Adult Echocardiography Reporting: Recommendations From the American Society of Echocardiography. J Am Soc Echocardiogr. 2025;38(9):735-74.
IX. Thomas B, Wulf S, Bikbov B, Perico N, Cortinovis M, Courville de Vaccaro K, et al. Maintenance Dialysis throughout the World in Years 1990 and 2010. (1533-3450 (Electronic)).
X. Moura AF, Moitinho JAO, da Luz LG, Suassuna JHR, Moura-Neto JA. Anemia in Dialysis Patients. In: Fadem SZ, Moura-Neto JA, Golper TA, editors. Complications in Dialysis: A Clinical Guide. Cham: Springer International Publishing; 2023. p. 157-70.
XI. Block GA, Klassen Ps Fau - Lazarus JM, Lazarus Jm Fau - Ofsthun N, Ofsthun N Fau - Lowrie EG, Lowrie Eg Fau - Chertow GM, Chertow GM. Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. (1046-6673 (Print)).
XII. Franczyk-Skóra B, Gluba-Brzózka A Fau - Wranicz JK, Wranicz Jk Fau - Banach M, Banach M Fau - Olszewski R, Olszewski R Fau - Rysz J, Rysz J. Sudden cardiac death in CKD patients. (1573-2584 (Electronic)).
XIII. Di Lullo L, Gorini A, Russo D, Santoboni A, Ronco C. Left Ventricular Hypertrophy in Chronic Kidney Disease Patients: From Pathophysiology to Treatment. (1664-3828 (Print)).
XIV. Winkelmayer WC, Patrick Ar Fau - Liu J, Liu J Fau - Brookhart MA, Brookhart Ma Fau - Setoguchi S, Setoguchi S. The increasing prevalence of atrial fibrillation among hemodialysis patients. (1533-3450 (Electronic)).
XV. Wizemann V, Tong L Fau - Satayathum S, Satayathum S Fau - Disney A, Disney A Fau - Akiba T, Akiba T Fau - Fissell RB, Fissell Rb Fau - Kerr PG, et al. Atrial fibrillation in hemodialysis patients: clinical features and associations with anticoagulant therapy. (1523-1755 (Electronic)).
XVI. Rautavaara J, Kerola T, Kaartinen K, Vilpakka M, Aitkoski A, Anttonen O, et al. Asystole episodes and bradycardia in patients with end-stage renal disease. (1460-2385 (Electronic)).
XVII. Genovesi S, Boriani G, Covic A, Vernooij RWM, Combe C, Burlacu A, et al. Sudden cardiac death in dialysis patients: different causes and management strategies. Nephrol Dial Transplant. 2021;36(3):396-405.
XVIII. Bleyer AJ, Hartman J Fau - Brannon PC, Brannon Pc Fau - Reeves-Daniel A, Reeves-Daniel A Fau - Satko SG, Satko Sg Fau - Russell G, Russell G. Characteristics of sudden death in hemodialysis patients. (0085-2538 (Print)).
XIX. Timofte D, Tanasescu MD, Balcangiu-Stroescu AE, Balan DG, Tulin A, Stiru O, et al. Dyselectrolytemia-management and implications in hemodialysis (Review). (1792-0981 (Print)).
XX. Sciacqua A, Perticone M, Tripepi G, Miceli S, Tassone EJ, Grillo N, et al. Renal disease and left atrial remodeling predict atrial fibrillation in patients with cardiovascular risk factors. International Journal of Cardiology. 2014;175(1):90-5.