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ABSTRACT
Background. Cardiac arrhythmia is frequently observed in patients with end-stage renal disease (ESRD), and it is associated with a high morbidity and mortality, but ECG studies in this group are rare. The aim of our study was to describe the occurrence, severity, and risk factors of cardiac arrhythmia in patients with ESRD in the North Cameroon region. Methods. We carried out a cross-sectional study in the hemodialysis units of two regional hospitals in the cities of Maroua and Garoua, Cameroon. Over a four month period in 2015, we consecutively recruited consenting adult patients on maintenance hemodialysis for at least three months. A 24-hour Holter ECG monitor was placed just before dialysis. Ventricular arrhythmia was classified according to Lown classification. Results. 30 participants (63.3% males) were included in the study. Their mean age was 42 ± 15.7 years (range 30 – 67 years). Hypertension was the most frequent co-morbid condition, present in 21 cases (70%). On standard ECG, 25 patients (83.3%) had normal sinus rhythm while 5 (16.7%) had sinus tachycardia. The mean ejection fraction (EF) was 64.4 ± 15%, and ranged from 32 to 83%. The most frequent pericardial finding was effusion (46.6%). The overall average heart rate was 85.7 ± 14.8 bpm, and ranged from 62 to 120 bpm. The most frequent arrhythmia on Holter ECG was PVC of varying degrees seen in 26 (86.7%) of patients. This was followed by supraventricular premature contractions (21, [70%]), which were all junctional in origin. Of those with PVC, 12 (46.2%) had complex arrhythmia. Six (20%) patients had salves of Premature Ventricular Contractions (PVC). Conclusion. Complex Premature ventricular contractions frequently occurred in patients on maintenance hemodialysis. This was associated with left ventricular systolic dysfunction. This stresses the need for a comprehensive cardiac evaluation including Holter-ECG recordings this group of patients.
RÉSUMÉ
Introduction. Les troubles du rythme cardiaques sont fréquemment observés chez les patients en
insuffisance rénale chronique terminale (IRCT) et sont associés à une grande morbimortalité. Le but de notre étude était d’identifier les principaux troubles du rythme cardiaque au HOLTER ECG de 24H chez les patients hémodialysés chroniques suivis dans deux centres d’hémodialyse au Nord Cameroun. Méthodes. Notre étude transversale descriptive a été menée dans 2 centres d’hémodialyse au Nord Cameroun (Garoua et Maroua) de Février à Mai 2015.Tous les patients hémodialysés depuis plus de 03 mois ayant accepté de participer à l’étude ont été inclus. Un enregistrement électrocardiographique de longue durée (HOLTER ECG) a été réalisé pendant 24H et débutait peu avant chaque séance de dialyse. Les extrasystoles ventriculaires (ESV) ont été classées selon la classification de LOWN. Résultats. 30 patients ont été retenus. La moyenne d’âge était de 42±15,65 ans, et les hommes représentaient 63,3% de l’effectif. La principale comorbidité retrouvée était l’hypertension artérielle (21 patients ,70%). A l’ECG standard 25 patients étaient en rythme sinusal normal tandis que 5 patients étaient en tachycardie sinusale. A l’échodoppler cardiaque la fraction d’éjection ventriculaire gauche moyenne était de 64.4 ± 15%. On a retrouvé dans 46% des cas un épanchement péricardique. Au Holter ECG la fréquence cardiaque moyenne de 24h était de 85.7 ± 14.8 bpm. Parmi les troubles du rythme détectés, les ESV étaient présentes dans 86,7% des cas dont 46,2% étaient classées comme complexes. Les extrasystoles supraventriculaires (ESSV) étaient retrouvées chez 70% des patients. Parmi les 12 (46,2%) patients qui avaient des ESV complexes, 6 patients avaient des salves d’ESV. Conclusion. Les ESV sont fréquentes chez les patients hémodialysés chroniques. Ces ESV sont associées à une altération de la fonction systolique ventriculaire gauche. Cela souligne la nécessité d'une évaluation cardiaque complète incluant un enregistrement Holter-ECG de 24h chez ce groupe de patients.
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References
- Alebiosu CO, Ayodele OE. The global burden of chronic kidney disease and the way forward. Ethn Dis. 2005; 15 (3):418.
- Levin A, Stevens PE, Bilous RW, Coresh J, De Francisco ALM, De Jong PE, et al. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group: KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1):e150.
- Grassmann A, Gioberge S, Moeller S, Brown G. ESRD patients in 2004: global overview of patient numbers, treatment modalities and associated trends. Nephrol Dial Transplant. 2005; 20 (12):2587–2593.
- Levey AS, Coresh J. Chronic kidney disease. The Lancet. 2012; 379 (9811): 165–180.
- Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. The Lancet. 2013; 382 (9888):260–272.
- Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. The Lancet. 2015 May 22; 385 (9981):1975–82.
- Schieppati A, Remuzzi G. Chronic renal diseases as a public health problem: epidemiology, social, and economic implications. Kidney Int. 2005; 68: S7–S10.
- Kaze FF, Kengne A-P, Djalloh AMA, Ashuntantang G, Halle MP, Menanga AP, et al. Pattern and correlates of cardiac lesions in a group of sub-Saharan African patients on maintenance hemodialysis. Pan Afr Med J. 2014 Jan 1; 17 (1).
- Foley RN, Gilbertson DT, Murray T, Collins AJ. Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med. 2011; 365(12): 1099–1107.
- Menanga AP, Ashuntantang G, Kollo D, Hamadou B, Kaze F, Wawo E, et al. Hyperkaliémie chez les Patients en Hémodialyse Chronique à Yaoundé: Prévalence, Manifestations Cliniques et Électrocardiographiques. Health Sci Dis. 2013
- Santoro A, Mancini E, London G, Mercadal L, Fessy H, Perrone B, et al. Patients with complex arrhythmias during and after haemodialysis suffer from different regimens of potassium removal. Nephrol Dial Transplant. 2008; 23 (4):1415–1421.
- Hasan Ali H, Maghraby MH, Mosad E, Abdel Sayed AA. Pattern and possible contributing factors to dialysis-associated arrhythmia in young patients. 2009;
- El Oury H, Khattabi I, Mahmal S, Najih H, Benchaouia Z, Kasongo A. Les troubles du rythme cardiaque chez les hémodialysés. Néphrologie Thérapeutique. 2014; 10 (5):295–296.
- Bozbas H, Atar I, Yildirir A, Ozgul A, Uyar M, Ozdemir N, et al. Prevalence and predictors of arrhythmia in end stage renal disease patients on hemodialysis. Ren Fail. 2007; 29 (3):331–9.
- World Medical Association. Declaration of Helsinki. Law Med Health Care Publ Am Soc Law Med. 1991 Fall-Winter; 19 (3–4):264–5.
- von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull World Health Organ. 2007 Nov; 85(11):867–72.
- Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016 Dec; 17 (12):1321–60.
- Bigger JT, Weld FM. Analysis of prognostic significance of ventricular arrhythmias after myocardial infarction. Shortcomings of Lown grading system. Br Heart J. 1981 Jun; 45 (6):717–24.
- Bergström J, Lindholm B. What are the causes and consequences of the chronic inflammatory state in chronic dialysis patients? Seminars in dialysis. Wiley Online Library; 2000 p. 163–164.
- Halle MP, Ashuntantang G, Kaze FF, Takongue C, Kengne A-P. Fatal outcomes among patients on maintenance haemodialysis in sub-Saharan Africa: a 10-year audit from the Douala General Hospital in Cameroon. BMC Nephrol. 2016; 17: 165.
- Halle MP, Kengne AP, Ashuntantang G. Referral of patients with kidney impairment for specialist care in a developing country of sub-Saharan Africa. Ren Fail. 2009; 31 (5):341–348.
- Kaze FF, Ekokobe FE, Halle MP, Fouda H, Menanga AP, Ashuntantang G. The clinical pattern of renal diseases in the nephrology in-patient unit of the Yaounde General Hospital in Cameroon: a five-year audit. Pan Afr Med J. 2015 Jan 1; 21 (1).
References
Alebiosu CO, Ayodele OE. The global burden of chronic kidney disease and the way forward. Ethn Dis. 2005; 15 (3):418.
Levin A, Stevens PE, Bilous RW, Coresh J, De Francisco ALM, De Jong PE, et al. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group: KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1):e150.
Grassmann A, Gioberge S, Moeller S, Brown G. ESRD patients in 2004: global overview of patient numbers, treatment modalities and associated trends. Nephrol Dial Transplant. 2005; 20 (12):2587–2593.
Levey AS, Coresh J. Chronic kidney disease. The Lancet. 2012; 379 (9811): 165–180.
Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. The Lancet. 2013; 382 (9888):260–272.
Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. The Lancet. 2015 May 22; 385 (9981):1975–82.
Schieppati A, Remuzzi G. Chronic renal diseases as a public health problem: epidemiology, social, and economic implications. Kidney Int. 2005; 68: S7–S10.
Kaze FF, Kengne A-P, Djalloh AMA, Ashuntantang G, Halle MP, Menanga AP, et al. Pattern and correlates of cardiac lesions in a group of sub-Saharan African patients on maintenance hemodialysis. Pan Afr Med J. 2014 Jan 1; 17 (1).
Foley RN, Gilbertson DT, Murray T, Collins AJ. Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med. 2011; 365(12): 1099–1107.
Menanga AP, Ashuntantang G, Kollo D, Hamadou B, Kaze F, Wawo E, et al. Hyperkaliémie chez les Patients en Hémodialyse Chronique à Yaoundé: Prévalence, Manifestations Cliniques et Électrocardiographiques. Health Sci Dis. 2013
Santoro A, Mancini E, London G, Mercadal L, Fessy H, Perrone B, et al. Patients with complex arrhythmias during and after haemodialysis suffer from different regimens of potassium removal. Nephrol Dial Transplant. 2008; 23 (4):1415–1421.
Hasan Ali H, Maghraby MH, Mosad E, Abdel Sayed AA. Pattern and possible contributing factors to dialysis-associated arrhythmia in young patients. 2009;
El Oury H, Khattabi I, Mahmal S, Najih H, Benchaouia Z, Kasongo A. Les troubles du rythme cardiaque chez les hémodialysés. Néphrologie Thérapeutique. 2014; 10 (5):295–296.
Bozbas H, Atar I, Yildirir A, Ozgul A, Uyar M, Ozdemir N, et al. Prevalence and predictors of arrhythmia in end stage renal disease patients on hemodialysis. Ren Fail. 2007; 29 (3):331–9.
World Medical Association. Declaration of Helsinki. Law Med Health Care Publ Am Soc Law Med. 1991 Fall-Winter; 19 (3–4):264–5.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull World Health Organ. 2007 Nov; 85(11):867–72.
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016 Dec; 17 (12):1321–60.
Bigger JT, Weld FM. Analysis of prognostic significance of ventricular arrhythmias after myocardial infarction. Shortcomings of Lown grading system. Br Heart J. 1981 Jun; 45 (6):717–24.
Bergström J, Lindholm B. What are the causes and consequences of the chronic inflammatory state in chronic dialysis patients? Seminars in dialysis. Wiley Online Library; 2000 p. 163–164.
Halle MP, Ashuntantang G, Kaze FF, Takongue C, Kengne A-P. Fatal outcomes among patients on maintenance haemodialysis in sub-Saharan Africa: a 10-year audit from the Douala General Hospital in Cameroon. BMC Nephrol. 2016; 17: 165.
Halle MP, Kengne AP, Ashuntantang G. Referral of patients with kidney impairment for specialist care in a developing country of sub-Saharan Africa. Ren Fail. 2009; 31 (5):341–348.
Kaze FF, Ekokobe FE, Halle MP, Fouda H, Menanga AP, Ashuntantang G. The clinical pattern of renal diseases in the nephrology in-patient unit of the Yaounde General Hospital in Cameroon: a five-year audit. Pan Afr Med J. 2015 Jan 1; 21 (1).