Aritmiler ve Kanıta Dayalı Tedavi Bakım Uygulamaları
Özet
Kronik Böbrek Hastalığı (KBH) dünya ve ülkemizde sık görülen bir sağlık sorunudur. Böbrek hastalığına bağlı olarak hastalar diyaliz tedavisi görmektedir. Hemodiyaliz esnasında hastalar birçok komplikasyonla karşılaşabilir. Aritmi bu komplikasyonlardan biri olmasının yanında ani kardiyak ölüme neden olmasından dolayı da büyük önem taşımaktadır. Elektrolit dengesizlikleri, sıvı değişimleri ve yapısal kardiyak değişiklikler gibi faktörler aritmi gelişimine katkı sağlayan faktörler arasındadır. Hemodiyaliz hastalarında aritmiye neden olan faktörlerin, aritmilerin türleri ve risk faktörlerinin belirlenmesi ve buna uygun önlemlerin alınması gereklidir. Kronik hastalığı olan ve kompleks izlem gerektiren hemodiyaliz hastalarında multidisipliner takip çok önemlidir. Hastaların multidisipliner takibi, hasta güvenliği, yaşam süresi ve kalitesinin arttırılmasında öneme sahiptir. Bakımın standardize edilmesi, tıbbi hataların ve uygulamalardaki farklılıkların azaltılması, hizmet kalitesinin artması için kanıta dayalı uygulamaların önemi giderek artmaktadır. Kanıta dayalı uygulamalar komplikasyonları azaltır ve hasta güvenliğini artırır. Bu nedenle tüm sağlık profesyonellerinin güncel rehber ve literatür doğrultusunda uygulama yapması büyük önem taşır. Hemodiyaliz esnasında karşılaşılan aritmi ile ilgili kanıta dayalı yaklaşımların paylaşılması amaçlanmaktadır.
Referanslar
K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. American Journal of Kidney Diseases. 2002; 39 (2 Suppl 1): S1-266.
Seyahi N, Ateş K, Süleymanlar G. Current Status of Renal Replacement Therapies in Turkey: Summary of Turkish Society of Nephrology Registry 2016 Report. Turkısh Nephrology Dialysıs Transplantation Journal. 2018; 27 (2): 133-139.
US Renal Data System. USRDS 2018 Annual Data Report: Atlas of End-Stage Renal Disease in theUnited States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2018.
Pun PH. The Interplay Between CKD, Sudden Cardiac Death, and Ventricular Arrhythmias. Advances in Chronic Kidney Disease. 2014; 21(6):480-488.
Hsieh H, Hsu S, Cheng H, et al. The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis. PLoS ONE. 2020;15(1): e0228405.
USRDS Yıllık Veri Raporu. Ölüm oranı. Betheseda: ABD Renal Veri Sistemi; 2011 [alıntı tarihi: 12 Nisan 2017]. https://www.usrds.org/2011/view/v2_05.asp
Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001; 285:2370-2375.
Zebe H. Atrial fibrillation in dialysis patients. Nephrology Dialysis Transplantation. 2000; 15:765-768.
Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. The New England Journal of Medıcıne. 2001; 345:1473-82. doı: http://dx.doi.org/10.1056/NEJMra000650.
Wan C, Herzog CA, Zareba W, et al. Sudden cardiac arrest in hemodialysis patients with wearable cardioverter defibrillator. Annals of Noninvasive Electrocardiology. 2014; 19:247-57.
Roy-Chaudhury P, Tumlin JA, Koplan BA, et al. İnvestigators and committees. Primary outcomes of the Monitoring in Dialysis Study indicate that clinically significant arrhythmias are common in hemodialysis patients and related to dialytic cycle. Kidney Internatıonal. 2018;93(4):941-951.
Sinha F, Schweda F, Maier LS, et al. Impact of Impaired Kidney Function on Arrhythmia-Promoting Cardiac Ion Channel Regulation. International Journal of Molecular Sciences. 2023; 24(18):14198. https://doi.org/10.3390/ijms241814198
Akhtar Z, Leung LW, Kontogiannis C, et al. Arrhythmias in Chronic Kidney Disease. European Cardiology Review. 2022; 17:1-10.
Wolk R. Arrhythmogenic mechanisms in left ventricular hypertrophy. Europace. 2000;2: 216–223.
Karaboyas A, Zee J, Brunelli SM, et al. Dialysate Potassium, Serum Potassium, Mortality, and Arrhythmia Events in Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS). American Journal of Kidney Diseases. 2017; 69(2): 266-277.
El-Sherif N Turitto G. Electrolyte disturbances and arrhythmogenesis. Cardiology Journal. 2011; 18:233–45.
Zaza A. Serum potassium and arrhythmias. Europace. 2009; 11:421–2.
Bushinsky DA. Contribution of intestine, bone, kidney, and dialysis to extracellular fluid calcium content. Clinical Journal of the Amerıcan Society of Nephrology. 2010;5(1): 12–22.
Genovesi S, Pogliani D, Faini A, et al. Prevalence of Atrial Fibrillation and Associated Factors in a Population of Long-Term Hemodialysis Patients. American Journal of Kidney Diseases. 2005; 46(5): 897-902.
El Hage N, Jaar BG, Cheng A. et al. Frequency of arrhythmia symptoms and acceptability of implantable cardiac monitors in Hemodialysis patients. BMC Nephrology. 2017; 18, 309. https://doi.org/10.1186/s12882-017-0740-1.
Yurdam FS, Kış M. Frequency and type of arrhythmia in Holter electrocardiogram in patients undergoing hemodialysis. Journal of Surgery and Medicine. 2023;7(1):75-78.
Herzog CA, Asinger RW, Berger AK, et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Internatıonal. 2011; 80: 572–586.
Evrenkaya TR, Atasoyu EM. Hemodiyaliz hastalarında iskemik kalp hastalığının tanı ve tedavisi. Nefroloji Dergisi. 2004; 13(2):79-85.
Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Internatıonal Supplements. 2012;2(4):279-335.
Pun PH, Lehrich RW, Honeycutt EF, et al. Modifiable risk factors associated with sudden cardiac arrest within hemodialysis clinics. Kidney Internatıonal. 2011;79(2):218–227.
Karnik JA, Young BS, Lew NL, et al. Cardiac arrest and sudden death in dialysis units. Kidney Internatıonal. 2001;60(1):350–357.
Jadoul M, Thumma J, Fuller DS, et al. Modifiable practices associated with sudden death among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Clinical journal of the American Society of Nephrology. 2012;7(5):765–774.
Pun PH, Horton JR, Middleton JP. Dialysate calcium concentration and the risk of sudden cardiac arrest in hemodialysis patients. Clinical Journal of the American Society Nephrology. 2013;8(5):797-803.
Chan CT, Floras JS, Miller JA, et al. Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Internatıonal. 2002;61(6):2235–2239.
Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis vs conventional hemodialysis on left ventricular mass and quality of life: a randomized controlled trial. JAMA. 2007;298(11):1291–1299.
Yang LJ, Hsu SM, Wu PH, et al. Association of digoxin with mortality in patients with advanced chronic kidney disease: A population-based cohort study. PLoS One. 2021;16(1):e0245620.
Elemshaty A, Sayed-Ahmed N, Mesbah A, et al. Could cooling dialysate improve inflammatory and nutritional status of hemodialysis patients?. BMC Nephrology. 2023; (24): 255 https://doi.org/10.1186/s12882-023-03305-z
Cuadrado E, Broseta JJ, Rodríguez-Espinosa D, et al. Tailoring the dialysate bicarbonate eliminates pre-dialysis acidosis and post-dialysis alkalosis. Clinical Kidney Journal. 2022;15(10):1946-1951. doi: 10.1093/ckj/sfac128.
Russo AM, Stainback RF, Bailey SR, et al. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: a report of the American College of Cardiology Foundation appropriate use criteria task force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. Heart Rhythm. 2013; 10:11–58.
Xu D, Murakoshi N, Sairenchi T, et al. Anemia and reduced kidney function as risk factors for new onset of atrial fibrillation (from the Ibaraki prefectural health study). The American Journal of Cardiology. 2015;115(3):328-333.
Su X, Yan B, Wang L. et al. Effect of antiplatelet therapy on cardiovascular and kidney outcomes in patients with chronic kidney disease: a systematic review and meta-analysis. BMC Nephrology. 2019; 20, 309. https://doi.org/10.1186/s12882-019-1499-3
Thomas SH, Behr ER. Pharmacological treatment of acquired QT prolongation and torsades de pointes. British Journal of Clinical Pharmacology. 2016;81(3):420-7. doi: 10.1111/bcp.12726.
Domanski MJ, Exner DV, Borkowf CB, et al. Effect of angiotensin converting enzyme inhibition on sudden cardiac death in patients following acute myocardial infarction. A meta-analysis of randomized clinical trials. Journal of the American College of Cardiology. 1999;33(3):598-604.
Cice G, Ferrara L, D'Andrea A, et al. Carvedilol increases two-year survivalin dialysis patients with dilated cardiomyopathy: a prospective, placebo-controlled trial. Journal of the American College of Cardiology. 2003; 41(9):1438-44.
Obialo CI, Ofili EO, Norris KC. Statins and Cardiovascular Disease Outcomes in Chronic Kidney Disease: Reaffirmation vs. Repudiation. Internatıonal Journal of Environmental Research Public Health. 2018;15(12):2733.
Barylski M, Nikfar S, Mikhailidis DP, et al. Statins decrease all-cause mortality only in CKD patients not requiring dialysis therapy—A meta-analysis of 11 randomized controlled trials involving 21,295 participants. Pharmacological Research. 2013; 72:35-44.
Yang LJ, Chao YL, Kuo IC, et al. High Ultrafiltration Rate Is Associated with Increased All-Cause Mortality in Incident Hemodialysis Patients with a High Cardiothoracic Ratio. Journal of Personalized Medicine. 2022;12(12):2059. doi: 10.3390/jpm12122059.
Delicata L, Gatt A, Paris JL, et al. Symptomatic digoxin toxicity in a patient on haemodialysis. BMJ Case Reports. 2020;13(6):e234899. doi: 10.1136/bcr-2020-234899.
Pun PH, Al-Khatib SM, Han JY, et al. Implantable cardioverter-defibrillators for primary prevention of sudden cardiac death in CKD: a meta-analysis of patient-level data from 3 randomized trials. American Journal of Kidney Diseases. 2014; 64: 32-39.Roberts PR Green D. Arrhythmias in chronic kidney disease. Heart. 2011; 97:766–73.
Basnet A, Naeem A, Sharma NR, et al. Atrial Fibrillation Ablation in Patients With Chronic Kidney Disease: A Review of Literature. Cureus. 2023;15(10):e46545. doi: 10.7759/cureus.46545
