Prevalence and Patterns of Cardiac Arrhythmias in Patients With Chronic Kidney Disease Undergoing Hemodialysis: A Retrospective Study

Background Cardiac arrhythmias are a leading cause of morbidity and mortality among patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis. Objective The objective of the study is to determine the prevalence and patterns of cardiac arrhythmias in CKD patients receiving maintenance hemodialysis and to identify clinical and dialysis-related factors associated with arrhythmia occurrence. Methods This retrospective cross-sectional study was conducted at Sir Ganga Ram Hospital, Lahore, Pakistan, from March 2022 to March 2025. A total of 155 patients undergoing maintenance hemodialysis were included using non-probability consecutive sampling. Data were extracted from hospital records, dialysis charts, and electrocardiographic (ECG) reports routinely recorded before, during, and after dialysis sessions, as well as 24-hour Holter monitoring reports when clinically indicated. Arrhythmias were categorized as atrial, ventricular, or bradyarrhythmic according to standard ECG criteria, and their timing relative to dialysis sessions (pre-, intra-, and post-dialysis) was documented. Only patients with complete clinical, dialysis, and ECG/Holter data were included. Results The mean age of participants was 52.6 ± 12.8 years, with 101 men (65.2%). Hypertension (72.3%), diabetes mellitus (57.4%), and ischemic heart disease (29.7%) were the most common comorbidities. Cardiac arrhythmias were identified in 97 patients (62.6%). Atrial fibrillation was the most frequent sustained arrhythmia (24.5%), followed by ventricular arrhythmias (20.0%) and bradyarrhythmias (10.3%). Arrhythmias were most commonly observed during dialysis (45.4%) and in the post-dialysis period (33.0%). On multivariate logistic regression analysis, arrhythmia occurrence was independently associated with age > 55 years (odds ratio (OR) = 1.9, 95% confidence interval (CI): 1.1-3.4; p = 0.02), hypertension (OR = 2.1, 95% CI: 1.1-4.0; p = 0.01), diabetes mellitus (OR = 1.8, 95% CI: 1.0-3.3; p = 0.04), ischemic heart disease (OR = 2.4, 95% CI: 1.2-4.9; p = 0.01), dialysis vintage > 5 years (OR = 2.2, 95% CI: 1.2-4.2; p = 0.02), and low-potassium dialysate use (OR = 2.6, 95% CI: 1.3-5.3; p = 0.005). Conclusion Cardiac arrhythmias are highly prevalent among patients receiving maintenance hemodialysis, with atrial fibrillation being the most common sustained type. Several patient-related and dialysis-related factors were associated with arrhythmia occurrence; however, these associations should be interpreted in the context of the retrospective, single-center design and clinically indicated rhythm monitoring. Prospective studies with systematic cardiac monitoring are warranted to further clarify causal relationships and preventive strategies.