長期洗腎病患40%死於心臟病,其中一半死於猝死;80%的洗腎病患具有與猝死相關之多重因素,其HRV則與心律不整高度相關
[Risk of sudden death in patients with chronic
renal failure and hemodialysis]
Rev
Med Chir Soc Med Nat Iasi. 2004; 108(2):290-5 (ISSN: 0300-8738)
Panaghiu L; Veisa G; Covic A; Alexa ID; Arsenescu C; Covic M
Spitalul Clinic Dr. C.I. Parhon
Ia?i, Clinica a IV-a
Medical?-Nefrologie, Universitatea
de Medicin? ?i Farmacie Gr.T. Popa Ia?i.
Cardiovascular
mortality in uremic patients treated by hemodialysis overrates ten times cardiovascular mortality
in general population. Approximatively 40% of
patients on iterative hemodialysis die from cardiac
diseases, half of cases by sudden death. Several risk factors for sudden death
are well known: QTc interval prolongation, decrease
of RR interval <750 msec, decrease of heart rate
variability, presence of late ventricular potentials (LVP), presence of high
risk ventricular extrasystoles, decrease of ejection
fraction (EF) <40 %, presence of left ventricular hypertrophy. Our study
evaluated the above-mentioned risk factors for sudden death in patients with
chronic renal failure on hemodialysis. We studied 37
patients, 22 males and 15 females, with mean age of 42 years old, without
diabetes, heart failure and arrhythmias, without myocardial ischemia on ECG,
being on hemodialysis (HD) programme
for minimum 1 year (HD parameters are: 4 h x 3/week, qB
= 300 ml/min, buffer = bicarbonate, Ca dialysate =
1.75 mmol/l, K dialysate =
2.1 mmol/l, conductivity = 135 mS).
The patients were evaluated by echocardiography, standard and Holter ECG. Statistics evaluation was performed in SPSS
v.9.0. Program. The results proved that 80% of
patients on HD have risk factors for sudden death, which are closely related
with age and hyperhydration. Statistics proved that
presence of high-risk arrhythmias is connected with heart rate variability and
prolongation of QTc interval (favored by HD). 50% of
our patients have 2 to 4 risk factors for sudden death, which increase
incidence of sudden death in patients on HD.