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Abstract: TH-PO268

Asymptomatic Heartbeat Irregularities (AHbI) During Hemodialysis (HD) Are Associated with Decreased Short-Term Survival

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Sapoznikov, Dan, Hadassah University Medical Center, Jerusalem, Israel
  • Backenroth, Rebecca, Hadassah University Medical Center, Jerusalem, Israel
  • Dranitzki Elhalel, Michal, Hadassah University Medical Center, Jerusalem, Israel
  • Rubinger, Dvora, Hadassah University Medical Center, Jerusalem, Israel
Background

Intradialytic AHbI are not well defined and are of unknown significance.

Methods

Beat-to-beat systolic blood pressure (SBP) and interbeat interval (IBI) were monitored during regular HD sessions in 83 age-matched patients (Pt). AHbI were defined as ≥10 irregular beats on a 4hr recording. Hemodynamic variability indices were assessed using Finometer device and Beatscope software .

Results

AHbI were detected in 25 Pt (AHbI (+)). The representative clinical, laboratory and hemodynamic data in AHbI (+) and in Pt with regular beats (AHbI(-)) are listed in Table 1.There were no statistically significant differences between groups regarding the proportion of diabetes, hypertension, ischemic heart disease, SBP, intradialytic hypotension, PTH level or ultrafiltration rate. Kaplan-Meier analysis showed a significnant decreased survival at 2y in AHbI(+) (Figure 1).

Conclusion

1.Intradialytic AHbI are associated with cardiovascular risk factors and a higher plasma phosphate level, suggesting a link between mineral metabolism and heart disease.
2. In AHbI (+), diminished post HD plasma potassium change combined with decreased IBI and increased sdCO suggest a tendency to hemodynamic instability leading to higher mortality.
The nature and the long term effects of the AHbI remain to be further explored.

Table 1.
 AHbI (+) (n=25)
Age 65±9 y
AHbI (-) (n=58)
Age 66±10 y
p
Male gender (n)22340.009
History of smoking (n,%)17 (68)19 (33)0.003
Left ventricular systolic dysfunction (n,%)13 (54)13 (24)0.008
Peripheral vascular disease (n,%)18 (72)28 (48)0.046
Plasma calcium (mmo/L)* ^2.25±0.172.27±0.17NS
Plasma phosphate (mmol/L)* ^1.69±0.371.46±0.310.004
Plasma potassium decrease after HD (mmol/L)^1.24±0.561.54±0.610.039
IBI (msec)**839 (122)891 (234)0.010
sdDBP (mmHg)^^ **3.7 (0.9)2.9 (1.3)0.003
sdCO (L/min)^^ **0.57 (0.25)0.44 (0.21)0.001

* Predialysis: ^mean±SD; **Median (interquartile range); ^^ sd (standard deviation) ; DBP: diastolic blood pressure; CO: cardiac output.

Figure 1.