Abstract:

Background: Cardiac diseases attributed to arrhythmic mechanisms are major causes of death among dialysis naïve and dialysis-experienced patients. A resting electrocardiogram (ECG) can detect some arrhythmogenic abnormalities associated with the risk of cardiovascular disease morbidity and mortality in chronic kidney disease (CKD) patients. This study aimed to determine the prevalence, patterns, and associated factors of arrhythmogenic electrocardiographic (ECG) abnormalities among CKD patients in Mwanza.

Methods: A hospital-based cross-sectional study was conducted among 162 CKD patients attending medical outpatient clinics in Bugando Medical Centre between November 2023 and March 2024. Demographic, clinical, laboratory, ECG, and echocardiographic findings were recorded and analyzed.

Results: 83 patients on regular hemodialysis and 79 patients with CKD stage 3–5 were included with a median age of 61. 103 (63.4%) were male and 107 (66%) of the study participants were asymptomatic during enrollment. ECG abnormalities were found in 134 (82.7%) of study participants with arrhythmogenic ECG abnormalities constituting 79.8% of all abnormalities. The most prevalent abnormalities were Prolonged QTc (46.9%), LVH (24.1%), Ischemic changes (23.5%), Atrioventricular blocks (AVB) (12.4%) and Intraventricular conduction defects (5.6%). Factors associated with arrhythmogenic ECG abnormalities included having comorbid conditions, reduced ejection fraction (EF<50%), and advanced CKD stage. In subgroup analysis, elevated BP during enrollment was associated with AVB, and the use of Calcium channel blockers and proton pump inhibitors was associated with Long QTc. Electrolyte abnormalities, dialysis status, and anemia had no statistically significant associations.

Conclusion: Arrhythmogenic ECG abnormalities are prevalent in the CKD population in our setting. We recommend regular ECG screening to detect arrhythmogenic changes in this population.