Hemodialysis Procedure Associated Autonomic Imbalance and Cardiac Arrhythmias: Insights from Continu
Our manuscript is published in the Journal of American Heart Association.
Our study showed several novel findings:
- Nonsustained ventricular tachycardia is more frequent during hemodialysis or within 6 hours post-hemodialysis.
- In incident hemodialysis patients, heart rate sharply increases before nonsustained ventricular tachycardia events, suggesting a triggered ventricular tachycardia mechanism.
- Every‐other‐day hemodialysis preserves physiological circadian rhythm in heart rate and heart rate variability, whereas the extension of the interdialytic period for the second day abolishes circadian rhythm and shows a steady deterioration in autonomic disbalance.
- The harmful effect of the 2‐day interval without hemodialysis suggests that more frequent dialysis should be considered the preferred prescribed treatment schedule.
Improvement of patient adherence—avoiding missing hemodialysis sessions—can improve patient outcomes.
- Diagnosis of autonomic imbalance in end‐stage kidney disease patients presenting with bradycardia is difficult. In end‐stage kidney disease, an autonomic disbalance is manifested by parasympathetic withdrawal and impaired baroreflex sensitivity, and use of β‐blockers attenuates association of heart rate with nonsustained ventricular tachycardia, suggesting potential treatment benefit of β‐blocker use, which should be studied further.
- Developed for this study Matlab software application is provided at https://github.com/Tereshchenkolab/HRV.