Monitoring of arrhythmia and sudden death in a hemodialysis population: The CRASH-ILR Study

PLoS One. 2017 Dec 14;12(12):e0188713. doi: 10.1371/journal.pone.0188713. eCollection 2017.


Introduction: It has been suggested that sudden cardiac death (SCD) contributes around 50% of cardiovascular and 27% of all-cause mortality in hemodialysis patients. The true burden of arrhythmias and arrhythmic deaths in this population, however, remains poorly characterised. Cardio Renal Arrhythmia Study in Hemodialysis (CRASH-ILR) is a prospective, implantable loop recorder single centre study of 30 established hemodialysis patients and one of the first to provide long-term ambulatory ECG monitoring.

Methods: 30 patients (60% male) aged 68±12 years receiving hemodialysis for 45±40 months with varied etiology (diabetes 37%, hypertension 23%) and left ventricular ejection fraction (LVEF) 55±8% received a Reveal XT implantable loop recorder (Medtronic, USA) between August 2011 and October 2014. ECG data from loop recorders were transmitted at each hemodialysis session using a remote monitoring system. Primary outcome was SCD or implantation of a (tachy or bradyarrhythmia controlling) device and secondary outcome, the development of arrhythmia necessitating medical intervention.

Results: During 379,512 hours of continuous ECG monitoring (mean 12,648±9,024 hours/patient), there were 8 deaths-2 SCD and 6 due to generalised deterioration/sepsis. 5 (20%) patients had a primary outcome event (2 SCD, 3 pacemaker implantations for bradyarrhythmia). 10 (33%) patients reached an arrhythmic primary or secondary end point. Median event free survival for any arrhythmia was 2.6 years (95% confidence intervals 1.6-3.6 years).

Conclusions: The findings confirm the high mortality rate seen in hemodialysis populations and contrary to initial expectations, bradyarrhythmias emerged as a common and potentially significant arrhythmic event.

MeSH terms

  • Aged
  • Arrhythmias, Cardiac / physiopathology*
  • Death, Sudden, Cardiac*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic*
  • Renal Dialysis*

Grant support

CRASH ILR is sponsored by Portsmouth Hospitals NHS Trust, UK and partly funded by an unrestricted grant from Medtronic Ltd, UK. The funders however had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.