title: Asymptomatic Intradialytic Supraventricular Arrhythmias and Adverse Outcomes in Patients on Hemodialysis.
abstract: Supraventricular arrhythmias are associated with high morbidity and mortality. Nevertheless, this condition has received little attention in patients on hemodialysis. The objective of this study was to analyze the incidence of intradialysis supraventricular arrhythmia and its long-term prognostic value.
  
  
  
  We designed an observational and prospective study in a cohort of patients on hemodialysis with a 10-year follow-up period. All patients were recruited for study participation and were not recruited for clinical indications. The study population comprised 77 patients (42 men and 35 women; mean age =58±15 years old) with sinus rhythm monitored using a Holter electrocardiogram over six consecutive hemodialysis sessions at recruitment.
  
  
  
  Hypertension was present in 68.8% of patients, and diabetes was present in 29.9% of patients. Supraventricular arrhythmias were recorded in 38 patients (49.3%); all of these were short, asymptomatic, and self-limiting. Age (hazard ratio, 1.04 per year; 95% confidence interval, 1.00 to 1.08) and right atrial enlargement (hazard ratio, 4.29; 95% confidence interval, 1.30 to 14.09) were associated with supraventricular arrhythmia in the multivariate analysis. During a median follow-up of 40 months, 57 patients died, and cardiovascular disease was the main cause of death (52.6%). The variables associated with all-cause mortality in the Cox model were age (hazard ratio, 1.04 per year; 95% confidence interval, 1.00 to 1.08), C-reactive protein (hazard ratio, 1.04 per 1 mg/L; 95% confidence interval, 1.00 to 1.08), and supraventricular arrhythmia (hazard ratio, 3.21; 95% confidence interval, 1.29 to 7.96). Patients with supraventricular arrhythmia also had a higher risk of nonfatal cardiovascular events (hazard ratio, 4.32; 95% confidence interval, 2.11 to 8.83) and symptomatic atrial fibrillation during follow-up (hazard ratio, 17.19; 95% confidence interval, 2.03 to 145.15).
  
  
  
  The incidence of intradialysis supraventricular arrhythmia was high in our hemodialysis study population. Supraventricular arrhythmias were short, asymptomatic, and self-limiting, and although silent, these arrhythmias were independently associated with mortality and cardiovascular events.
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Verde
authors.affiliation: Department of Cardiology, Hospital de León, León, Spain.
authors.forename: Armando
authors.initials: A
authors.lastname: Pérez de Prado
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: López-Gómez
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: Quiroga
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Marian
authors.initials: M
authors.lastname: Goicoechea
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: García-Prieto
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Torres
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Reque
authors.affiliation: Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Luño
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D002097:C-Reactive Protein / Q000378:metabolism; D006332:Cardiomegaly / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000401:mortality; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*
chemical_list: D002097:C-Reactive Protein
keywords: Arrhythmias; C-Reactive Protein; Cause of Death; Confidence Intervals; Electrocardiography; Follow-Up Studies; Heart Atria; Heart Conduction System; Incidence; Multivariate Analysis; Prevalence; Proportional Hazards Models; Prospective Studies; asymptomatic arrhythmias; atrial fibrillation; attention; chronic dialysis; diabetes mellitus; end-stage renal disease; female; hemodialysis; humans; hypertension; male; mortality