Intradialytic Heartbeat Irregularities (IR) Predict Increased Mortality in Patients on Chronic Hemodialysis (HD)

Background: The pressent study was undertaken to define the significance of asymptomatic IR during HD . Methods: Beat to beat systolic blood pressure (SBP) and interbeat interval (IBI) were monitored duriing HD in 96 age-matched HD patients (Pt). IR were defined as ≧5 irregular beats over 10 min during HD. Hemodynamic variability indices were assessed using Finometer device and beatscope software. Results: IR were detected im 29 Pt (IR(+)). The representative clinical data in IR (+) and in Pt with regular beats (IR (-) n=67) are listed in Table 1.There were no marked differences between groups regarding the proportion of diabetes (DM), hypertension, ischemic heart disease, history of previous arrhrythmia. biochemical measurements or anthypertensive medication. Kaplan Meier showed a significant decreased survival at 2 to 5, but not at 7 years (y) or later in IR (+) (Figure 1). Conclusion: Intradialytic IR were more frequent in Pt with a background of smoking and LV systolic dysfunction. In these Pt, decreased SBP at the end of HD and increased variabilities of CO and TPR might have contributed to hemodynamic instability. IR were associated with significntly enhanced mortality in HD.Figure 1. Table 1. - IR (-) (n=67, age 66±9 y) IR (+) (n=29, age 65±12 y) p Males/Females 41/26 25/4 0.015 DM (n/%) 34/51 9/31 NS Hypertension (n/%) 65/97 27/93 NS Ischemic heart disease (n/%) 53/79 19/66 NS Smokers (n/%) 26/39 19/66 0.025 LV systolic dysfunction (n/%) 18/28 13/52 0.031 Δ SBP (mmHg)* # 1±27 -13±20 0.012 IBI (msec) ** 887 (249) 834 (102)^ 0.033 sdCO (l/min)** 0.46 (0.21) 0.60 (0.18)^ 0.001 sdTPR (mmHG.s/ ml)** 0.08 (0.06) 0.11 (0.11)^ 0.040 *mean ± SD ; # post dialysis SBP change; **Median (interquartile range); sd: standard deviation; CO: cardiac output; TPR:: total peripheral resistance; ^ determined in 16 IR (+).