ABSTRACT
BACKGROUND: The presence of acute renal injury has been associated with increased cardiovascular morbidity and mortality (sudden death and arrhythmias). OBJECTIVE: To know the frequency of heart rhythm disorders documented by Holter in patients in need of intermittent hemodialysis due to acute renal injury. MATERIAL AND METHODS: A prospective observational study was conducted including patients with a diagnosis of acute renal injury who received intermittent hemodialysis; demographic, clinical and laboratory data were collected from 28 patients. Monitoring was carried out through Holter before, during and after the hemodialysis session. Nonparametric statistics were used, with a significant value of p < 0.05. Risks were established with logistic regression. RESULTS: There was a significant difference in supraventricular extra systoles (82.1% vs. 57.1%), ventricular extra systoles (26.7% vs. 3.6%), and supraventricular tachycardia (6.7% vs. 3.6%). The rest of the rhythm alterations without significance. CONCLUSIONS: Intermittent hemodialysis is a factor associated with the appearance of heart rhythm disorders. The death of patients with acute renal injury and substitution was related to ventricular extra systole detected by transhemodialysis Holter.
INTRODUCCIÓN: La presencia de lesión renal aguda se ha asociado a unas mayores morbilidad y mortalidad de causa cardiovascular (muerte súbita y arritmias). OBJETIVO: Conocer la frecuencia de trastornos del ritmo cardiaco documentado por Holter en pacientes con necesidad de hemodiálisis intermitente por lesión renal aguda. MATERIAL Y MÉTODOS: Se realizó un estudio observacional, prospectivo, en pacientes con diagnóstico de lesión renal aguda que recibieron hemodiálisis intermitente; se recabaron datos demográficos, clínicos y de laboratorio de 28 pacientes. Se realizó monitoreo mediante Holter, previo, durante y posterior a la sesión de hemodiálisis. Se utilizó estadística no paramétrica, con un valor significativo de p < 0.05. Se establecieron riesgos con regresión logística. RESULTADOS: Hubo diferencia significativa en extrasístoles supraventriculares (82.1% frente a 57.1%), extrasístoles ventriculares (26.7% frente a 3.6%) y taquicardia supraventricular (6.7% frente a 3.6%). El resto de las alteraciones del ritmo no mostraron significancia. CONCLUSIONES: La hemodiálisis intermitente es un factor asociado a la aparición de trastornos del ritmo cardiaco. La muerte de los pacientes con lesión renal aguda y sustitución estuvo relacionada con la extrasístole ventricular detectada por Holter transhemodiálisis.
Subject(s)
Acute Kidney Injury , Electrocardiography, Ambulatory , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , Humans , Prospective Studies , Renal Dialysis/adverse effectsABSTRACT
INTRODUCTION: Mexico is the country with the highest mortality due to acute myocardial infarction in adults older than 45 years old according to the OECD (28 vs. 7.5% of the average). The first real-world study, RENASCA IMSS, showed a high-risk population at 65%, but 50% without reperfusion strategies. The aim was to describe the clinical presentation, treatment, and outcomes of acute coronary syndromes at the IMSS. METHODS: RENASCA IMSS is a nation-wide, prospective, longitudinal-cohort study. We include consecutive patients with an Acute Coronary Syndrome diagnosis (ACC/AHA/ESC) admitted in 177 representative hospitals of the IMSS (166 of second level and 11 of third level of attention). In an electronic database clinical, paraclinical, times, reperfusion treatment, complications, and other variables were assessed. Confidentiality was maintained in data and informed consent was obtained. Registrer calibration was performed with more than 80% of the variables and 80% of the cases. RESULTS: From March 1, 2014 to December 25, 2017; 21,827 patients were enrolled presenting an average age 63.2 ± 11.7, 75% men (16,259) and 25% women (5,568). The most frequent risk factors were: hypertension (60.5%), smoking (46.8%), diabetes (45.5%), dyslipidemia (35.3%) and metabolic syndrome (39.1%). STEMI diagnosis was established in 73.2% of the patients and NSTEMI in 26.8%. The STEMI group within the Code Infarction showed an improvement in the reperfusion therapy (34.9% before vs. 71.4% after, p ≤0.0001) and reduction of mortality (21.1 vs. 9.4%, p ≤0.0001); while the NSTEMI group showed high risk set by a GRACE score of 131.5 ± 43.7 vs. 135.9 + 41.7, p ≤0.0001. Mortality was more frequent within the STEMI group (14.9 vs. 7.6%, p ≤0.0001). CONCLUSIONS: RENASCA IMSS study represents the largest Acute Coronary Syndromes real-world study in Mexico, demonstrating that the Mexican population has a high risk. Patients with a STEMI diagnosis were more frequently enrolled and were associated with higher mortality and complications; however, there is improvement in the reperfusion therapy and in mortality with the Code Infarction strategy.