The following is a summary of “Arrhythmia and Time of Day in Maintenance Hemodialysis: Secondary Analysis of the Monitoring in Dialysis Study,” published in the April 2024 issue of Nephrology by Soomro et al. 

Researchers conducted a prospective study analyzing the relationship between arrhythmia, time of day, and dialysis timing. 

They used loop recorders for continuous cardiac monitoring in 66 participants on maintenance dialysis with a 6-month follow-up. Monitoring in Dialysis study data for differences in diurnal arrhythmia patterns in end-stage kidney disease with and without heart failure were analyzed using binomial mixed effects regression models. The analysis included variables like heart failure presence, dialysis shift, and dialysis vs. non-dialysis days.

The results showed arrhythmia rates peaked between 12:00 AM and 5:59 AM and were 1.5-fold as frequent between midnight and early morning. Variations in atrial fibrillation peaked between 6:00 AM and 11:59 AM; however, the variations across the day were qualitatively small. Individuals with end-stage kidney disease and heart failure had a higher rate of clinically significant arrhythmia (5.9 events/mo; 95% CI, 1.3-26.8) compared to patients without heart failure (4.0 events/mo; 95% CI, 0.9-17.9). Periodicity differed significantly (P< 0.001), with peak occurrence between 12:00 AM and 6:00 AM in kidney failure alone and between 6:00 AM and 11:59 AM in heart failure. Rates were similar for morning and evening dialysis shifts overall (P = 0.43). Still, periodicity differed, with a peak between 12:00 AM and 5:59 AM for morning dialysis and between 6:00 AM and 11:59 AM for evening shifts.

Investigators concluded that clinically significant arrhythmias peaked between midnight and noon, differing for individuals with and without heart failure. Further research on circadian rhythms’ influence on arrhythmias during hemodialysis is warranted.

Source: sciencedirect.com/science/article/pii/S2590059524000104