title: Arrhythmia and Sudden Death in Hemodialysis Patients: Protocol and Baseline Characteristics of the Monitoring in Dialysis Study.
abstract: BACKGROUND
  Dialysis patients have high rates of cardiovascular morbidity and mortality, but data on arrhythmia burden, arrhythmia type, arrhythmia triggers, and the identity of terminal arrhythmias have historically been limited by an inability to monitor heart rhythm for prolonged periods.
  
  
  OBJECTIVE
  To investigate arrhythmia and its association with sudden death in dialysis-dependent ESRD, describe the potential for implantable devices to advance study of dialysis physiology, review the ethical implications of using implantable devices in clinical studies, and report on the protocol and baseline results of the Monitoring in Dialysis Study (MiD).
  
  
  METHODS
  In this multicenter, interventional-observational, prospective cohort study, we placed implantable loop recorders in patients undergoing long-term hemodialysis. The proportion of patients experiencing clinically significant arrhythmias was the primary endpoint. For 6 months, we captured detailed data on the primary endpoint, symptomatic arrhythmias, other electrocardiographic variables, dialysis prescription, electrolytes, dialysis-related variables, and vital signs. We collected additional electrocardiographic data for up to 1 year.
  
  
  RESULTS
  Overall, 66 patients underwent implantation in sites in the United States and India. Diabetes was present in 63.6% of patients, 12.1% were age ≥70 years, 69.7% were men, and 53.0% were black. Primary and secondary endpoint data are expected in 2016.
  
  
  CONCLUSIONS
  Cardiac arrhythmia is an important contributor to cardiovascular morbidity and mortality in dialysis patients, but available technology has previously limited the ability to estimate its true burden and triggers and to define terminal rhythms in sudden death. Use of implantable technology in observational studies raises complex issues but may greatly expand understanding of dialysis physiology. The use of implantable loop recorders in MiD is among the first examples of such a trial, and the results are expected to provide novel insights into the nature of arrhythmia in hemodialysis patients.
authors.affiliation: Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts; Dcharytan@partners.org.
authors.forename: David M
authors.initials: DM
authors.lastname: Charytan
authors.affiliation: Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota;
authors.forename: Robert
authors.initials: R
authors.lastname: Foley
authors.affiliation: Department of Medicine, Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas; Department of Medicine, Division of Cardiology, The Heart Hospital, Plano, Texas;
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.affiliation: Department of Cardiology, Scripps Clinic, Torrey Pines, California;
authors.forename: John D
authors.initials: JD
authors.lastname: Rogers
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Peter
authors.initials: P
authors.lastname: Zimetbaum
authors.affiliation: Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota;
authors.forename: Charles A
authors.initials: CA
authors.lastname: Herzog
authors.affiliation: Department of Medicine, University of Tennessee, Chattanooga College of Medicine, Chattanooga, Tennessee.
authors.forename: James A
authors.initials: JA
authors.lastname: Tumlin
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000517:prevention & control*; D002985:Clinical Protocols; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation; D011446:Prospective Studies; D019736:Prostheses and Implants; D006435:Renal Dialysis
keywords: arrhythmias; cardiac; cardiovascular disease; chronic; clinical trial; cohort studies; death; heart conduction system; hemodialysis; humans; kidney failure; renal dialysis; sudden