The Frequency, Causes and Patterns of Asymptomatic Cardiac Arrhythmias in Patients on Maintenance Hemodialysis

The knowledge of the incidence of non-severe and clinically significant arrhythmias is limited in patients with chronic kidney disease (CKD). The present study was conducted to determine the incidence, pattern and identify the factors predisposing to cardiac arrhythmias in patients on maintenance hemodialysis. Forty-five patients were included in this prospective observational study conducted between June 2020 and November 2021. Patients ≥ 18 years of age on maintenance hemodialysis (three times/week for at least three months), with no intercurrent illness, uremic symptoms, and not hospitalized in the previous 3 months were included. Demographic and clinical characteristics of the patients were noted. Arrhythmias were recorded by attaching the Holter machine to all study patients undergoing hemodialysis. We estimated the incidence, identified the pattern of cardiac arrhythmias, and explored the factors predisposing to cardiac arrhythmias. Premature atrial complexes (17.8%), premature ventricular complexes (31.1%), ventricular bigeminy (8.9%), trigeminy (8.9%), and ventricular couplets (22.2%) were observed. The patients with hyperparathyroidism, hyper/hypomagnesemia, and poor blood pressure control had significantly higher percentages of total and ventricular arrhythmias. The patients with hypomagnesemia, reduced left ventricular ejection fraction (<50%), poor blood pressure control, and receiving statins had significantly higher percentages of atrial arrhythmias. There was no statistically significant association between age, gender, diabetes mellitus, ischaemic heart disease, interdialytic weight gain, dialysis vintage, low hemoglobin, serum calcium levels, serum potassium levels, presence of left ventricular hypertrophy, pulmonary hypertension, and diastolic dysfunction with arrhythmias. A high incidence of cardiac arrhythmias was noted among patients on hemodialysis.