title: Asymptomatic Ventricular Arrhythmia and Clinical Outcomes in Chronic Kidney Disease: A Pilot Study.
abstract: OBJECTIVE
  Ventricular arrhythmia is associated with increased risk of cardiovascular events and death in the general population. Sudden death is a leading cause of death in end-stage renal disease. We aimed at evaluating the effects of ventricular arrhythmia on clinical outcomes in patients with earlier stages of chronic kidney disease (CKD).
  
  
  METHODS
  In a prospective study of 109 nondialyzed CKD patients (estimated glomerular filtration rate 34.8 ± 16.1 ml/min/1.73 m2, 57 ± 11.4 years, 61% male, 24% diabetics), we tested the hypothesis that the presence of subclinical complex ventricular arrhythmia, assessed by 24-hour electrocardiogram, is associated with increased risks of cardiovascular events, hospitalization, and death and with their composite outcome during 24 months of follow-up. Complex ventricular arrhythmia was defined as the presence of multifocal ventricular extrasystoles, paired ventricular extrasystoles, nonsustained ventricular tachycardia, or R wave over T wave.
  
  
  RESULTS
  We identified complex ventricular arrhythmia in 14% of participants at baseline. During follow-up, 11 cardiovascular events, 15 hospitalizations, and 4 deaths occurred. The presence of complex ventricular arrhythmia was associated with cardiovascular events (p < 0.001), hospitalization (p = 0.018), mortality (p < 0.001), and the composite outcome (p < 0.001). In multivariate Cox regression analysis, adjusting for demographic characteristics, complex ventricular arrhythmia was associated with increased risk of the composite outcome (HR 4.40; 95% CI 1.60-12.12; p = 0.004).
  
  
  CONCLUSIONS
  In this pilot study, the presence of asymptomatic complex ventricular arrhythmia was associated with poor clinical outcomes in nondialyzed CKD patients.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Fabiana Oliveira Bastos
authors.initials: FO
authors.lastname: Bonato
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Renato
authors.initials: R
authors.lastname: Watanabe
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Marcelo Montebello
authors.initials: MM
authors.lastname: Lemos
authors.affiliation: Cardios Research Institute, São Paulo, Brazil.
authors.forename: José Luiz
authors.initials: JL
authors.lastname: Cassiolato
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine and Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill., USA.
authors.forename: Myles
authors.initials: M
authors.lastname: Wolf
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Maria Eugênia Fernandes
authors.initials: ME
authors.lastname: Canziani
keywords: Cardiac arrhythmia; Cardiovascular disease; Chronic kidney disease; Ventricular arrhythmia