title: Temporal distribution of arrhythmic events in chronic kidney disease: Highest incidence in the long interdialytic period.
abstract: BACKGROUND
  Chronic kidney disease (CKD) patients undergoing hemodialysis (HD) have a high risk of sudden cardiac death (SCD). A unique risk factor may be a longer interval between HD sessions (interdialytic period). Inherent in conventional HD (thrice-weekly) are two 48-hour short breaks (SIDP) and one 72-hour long break (LIDP) between HD sessions.
  
  
  OBJECTIVE
  We used an implantable cardiac monitor (ICM) to define the incidence and timing of significant arrhythmias in an HD population.
  
  
  METHODS
  Fifty CKD patients undergoing HD with left ventricular ejection fraction >35% had an ICM inserted, with intensive follow-up to record SCD events and predefined bradyarrhythmias and tachyarrhythmias.
  
  
  RESULTS
  Mean age of the patients was 67 ± 11 years; 72% were male, and the mean follow-up was 18 ± 4 months. There were 8 unexpected SCDs (16%), all during the LIDP. The terminal event was severe bradycardia with asystole in each recorded case. No episodes of polymorphic ventricular tachycardia (VT) occurred. A total of 7686 arrhythmia events were recorded in 43 patients (86%), including bradycardia in 15 patients (30%), sinus arrest in 14 (28%), second-degree atrioventricular block in 4 (8%), nonsustained VT in 10 (20%), and new-onset paroxysmal atrial fibrillation in 14 (28%). The LIDP was the highest-risk period for all arrhythmias (P < .001). The arrhythmia event rate per hour was greatest during the first pre-HD period of the week compared with any other peri-HD period (P < .001).
  
  
  CONCLUSIONS
  Risk of SCD and significant arrhythmias is greatest during the LIDP. SCD was attributable to severe bradycardia and asystole. Interventions to prevent this type of SCD or shorten the LIDP deserve further evaluation.
  
  
  BACKGROUND
  URL: https://www.anzctr.org.au (Unique identifier: ACTRN12613001326785).
authors.affiliation: Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Michael C G
authors.initials: MC
authors.lastname: Wong
authors.affiliation: Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Pedagogos
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Nigel
authors.initials: N
authors.lastname: Toussaint
authors.affiliation: Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Jitendra K
authors.initials: JK
authors.lastname: Vohra
authors.affiliation: Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Sparks
authors.affiliation: Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Prashanthan
authors.initials: P
authors.lastname: Sanders
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Australia; The Baker IDI Research Institute, Melbourne, Australia; The Heart Centre, The Alfred Hospital, Melbourne, Australia.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Kistler
authors.affiliation: Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Halloran
authors.affiliation: Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Western Hospital, Melbourne, Australia.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Joseph
authors.affiliation: Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. Electronic address: joseph.morton@mh.org.au.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Morton
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D014739:Victoria / Q000453:epidemiology
keywords: Arrhythmia; Bradycardia; Chronic kidney disease; Hemodialysis; Interdialytic; Sudden death