الفهرس 
Cardiovascular complication in hemodialysis patientsOnly 14 pages are availabe for public view
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Abstract
Background: chronic kidney disease patients usually experience several comorbid conditions including cardiovascular disorders and at final end-stage renal disease (ESRD) stage, cardiovascular mortality accounts for about 50% of total mortality. End-stage renal disease (ESRD) patients commonly have a higher risk of developing cardiovascular diseases than general population. chronic kidney disease is an independent risk factor for atrial fibrillation (AF); however, little is known about the AF risk among ESRD patients with various modalities of renal replacement therapy.
Aim of the Work: To detect the incidence of AF in hemodialysis patients during six months.
Patients and Methods: The study was a prospective cohort study for six months included 250 adult patients with end stage renal diseases on regular hemodialysis sessions in National Institute of Urology and Nephrology in CAIRO, EGYPT for at least six months with no past history suggestive of any arrhythmias and normal holter ECG at the start of the study.
Results: The study includes 250 patients from whom 37 patients refuse follow up after 6 months and 18 patients was died before our follow up holter ECG so mortality rate 14.4% .In our study population there were 102 male patients (52.3%) and 93 female patients (47.7%) with mean age 54.39 ± 9.98 (19:73) and BMI 29.01±1.28 (24.5:34). In study population 96 patients were diabetic (49.2%), 84 patients were hypertensive (43.1%), 100patients were with ischemic heart diseases (51.3%) with median renal replacement duration 4 (3 – 6) with range (1 – 13). The main etiological causes of dialysis were diabetes mellitus, hypertension and analgesic nephropathy and other different causes of dialysis 35 patients (45%).The study showed association between incidence of AF in hemodialysis patients and different factors as increased BMI (0.006), prolonged duration of renal replacement therapy (0.017), diabetes mellitus (0.005), hypertension (0.000), ischemic heart diseases (0.02) and left atrium dilation (0.000).
Conclusion: The incidence of AF in patients with ESRD is 16.4% .The risk factors for increased incidence of AF in hemodialysis are; increased BMI, increased duration of renal replacement therapy, hypertension, diabetes mellitus, ischemic heart diseases and left atrium dilation by echocardiography.
hemodialysis patients have multiple risk factors for arrhythmias and should be closely monitored for early detection of atrial fibrillation or other arrhythmias espically obese patients with BMI more than 29.8 KG/ m2 or patients with diabetes mellitus, hypertension, ischemic heart diseases or all and with increased duration of renal replacement therapy.
Hemodialysis patients should be followed up by echocardiographyevery at least 6 months for early detection of left atrium dilation which is strong risk factor for AF.
All patients should continue on regular hemodialysis 3 times per week with session duration 4 hours completely as decrease duration of session or number of session per week lead to inadequate dialysis and lead to hyperkalemia which lead to increased incidence of arrhythmias especially bradyarrhythmias.
Further studies should include larger numbers of dialysis patients with matched age group, increase the duration of follow up more than six months, increase holter ECG follow up duration and selection of patients from multiple dialysis centers and assess serum electrolytes before and after dialysis session for new incident cases