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3 results on '"Kraig Wangsnes"'

1. Arrhythmia and Time of Day in Maintenance Hemodialysis: Secondary Analysis of the Monitoring in Dialysis Study

Author

Qandeel H. Soomro, Bruce A. Koplan, Alexandru I. Costea, Prabir Roy-Chaudhury, James A. Tumlin, Vijay Kher, Don E. Williamson, Saurabh Pokhariyal, Candace K. McClure, David M. Charytan, Don Williamson, James Tumlin, Vikranth Reddy, Kowdle Chandrasekhar Prakash, David Charytan, Suresh Chandra Tiwari, Amber Podoll, Sanjeev Jasuja, G. Leslie Walters, Kraig Wangsnes, Alexandru Costea, Selcuk Tombul, Balbir Singh, Brajesh Mishra, Sachin Yalagudri, Abhijeet Shelke, Calambur Narasimhan, A.M. Karthigesan, Abraham Oomman, K.P. Pramod Kumar, Bruce Koplan, Upendra Kaul, Tapan Ghose, Ripen Gupta, Arvind Sethi, Nikhil Kumar, Ramesh Hariharan, Rajnish Sardana, Arif Wahab, N.N. Khanna, Mark Smith, Suresh Kamath, Claude Galphin, Puneet Sodhi, Rajsekara Chakravarthy, Subba Rao Budithi, Finnian McCausland, Sanjeev Gulati, Munawer Dijoo, Upendra Singh, Salil Jain, Vishal Saxena, Gaurav Sagar, Rachel Fissell, Robert Foley, Charles A. Herzog, Peter McCullough, John D. Rogers, Peter Zimetbaum, Manish Assar, Mark Kremers, and Wolfgang C. Winkelmayer

Subjects
Arrhythmia, atrial fibrillation, bradycardia, circadian rhythm, dialysis, end-stage kidney disease, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Rationale & Objective: The incidence of arrhythmia varies by time of day. How this affects individuals on maintenance dialysis is uncertain. Our objective was to quantify the relationship of arrhythmia with the time of day and timing of dialysis. Study Design: Secondary analysis of the Monitoring in Dialysis study, a multicenter prospective cohort study. Settings & Participants: Loop recorders were implanted for continuous cardiac monitoring in 66 participants on maintenance dialysis with a follow up of 6 months. Exposure: Time of day based on 6-hour intervals. Outcomes: Event rates of clinically significant arrhythmia. Analytical Approach: Negative binomial mixed effects regression models for repeated measures were used to evaluate data from the Monitoring in Dialysis study for differences in diurnal patterns of clinically significant arrhythmia among those with end-stage kidney disease with heart failure and end-stage kidney disease alone. We additionally analyzed rates according to presence of heart failure, time of dialysis shift, and dialysis versus nondialysis day. Results: Rates of clinically significant arrhythmia peaked between 12:00 AM and 5:59 AM and were more than 1.5-fold as frequent during this interval than the rest of the day. In contrast, variations in atrial fibrillation peaked between 6:00 AM and 11:59 AM, but variations across the day were qualitatively small. Clinically significant arrhythmia occurred at numerically higher rate in individuals with end-stage kidney disease and heart failure (5.9 events/mo; 95% CI, 1.3-26.8) than those without heart failure (4.0 events/mo; 95% CI, 0.9-17.9). Although differences in overall rate were not significant, their periodicity was significantly different (P

Published
2024
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2. Implantable Loop Recorder Monitoring and the Incidence of Previously Unrecognized Atrial Fibrillation in Patients on Hemodialysis

Author

Bruce A. Koplan, Wolfgang C. Winkelmayer, Alexandru I. Costea, Prabir Roy-Chaudhury, James A. Tumlin, Vijay Kher, Don E. Williamson, Saurabh Pokhariyal, David M. Charytan, Don Williamson, MD, Prabir Roy-Chaudhury, MD, James Tumlin, MD, Vijay Kher, MD, Vikranth Reddy, MD, Kowdle Chandrasekhar Prakash, MD, David Charytan, MD MSc, Suresh Chandra Tiwari, MD, Saurabh Pokhariyal, MD, Amber Podoll, MD, Sanjeev Jasuja, MD, G. Leslie Walters, MD, Kraig Wangsnes, MD, Alexandru Costea, MD, Selcuk Tombul, MD, Balbir Singh, MD, Brajesh Mishra, MD, Sachin Yalagudri, MD, Abhijeet Shelke, MD, Calambur Narasimhan, MD, A.M. Karthigesan, MD, Abraham Oomman, MD, K P Pramod Kumar, MD, Bruce Koplan, MD, Upendra Kaul, MD, Tapan Ghose, MD, Ripen Gupta, MD, Arvind Sethi, MD, Nikhil Kumar, MD, Ramesh Hariharan, MD, Rajnish Sardana, MD, Arif Wahab, MD, N.N. Khanna, MD, Mark Smith, MD, Suresh Kamath, MD, Claude Galphin, MD, Puneet Sodhi, MD, Rajsekara Chakravarthy, MD, Subba Rao Budithi, MD, Finnian McCausland, MB, MMSc, Sanjeev Gulati, MD, Munawer Dijoo, MD, Upendra Singh, MD, Salil Jain, MD, Vishal Saxena, MD, Gaurav Sagar, MD, David Charytan, MD, MSc, Rachel Fissell, MD, Robert Foley, MD, Charles A. Herzog, MD, Peter A. McCullough, MD, John D. Rogers, MD, James A. Tumlin, MD, Peter Zimetbaum, MD, Manish Assar, MD, Mark Kremers, MD, and Wolfgang C. Winkelmayer, MD, ScD

Subjects
arrhythmias, atrial fibrillation, hemodialysis, kidney failure, end stage kidney diseae (ESKD), implantable loop recorder, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Introduction: Atrial fibrillation (AF) is common in patients with kidney failure on hemodialysis (KF-HD). We determined both AF incidence and burden in patients with KF-HD using implantable loop recorder (ILR) monitoring. Methods: Patients with KF-HD were enrolled and received an ILR. In 6 monitoring months, the incidence of AF events lasting ≥6 minutes was captured. Demographic, clinical, and dialysis characteristics were collected, and associations with incident AF were estimated using negative binomial regression models and expressed as incidence rate ratios and 95% CIs. Results: We enrolled 66 patients with KF-HD (mean age = 56 years, 70% male); 59 (90%) were without previously diagnosed AF. AF lasting ≥6 minutes was detected in 18 of 59 subjects (31%) without previously diagnosed AF and in 5 of 7 subjects (71%) with a previous AF diagnosis. Among the 23 with detected AF, episodes were present on 16% of patient days. Although 14 of 23 patients (61%) had AF on 2.5 vs. 2.5 mEq/l: incidence rate ratio = 0.62; 95% CI, 0.48–0.80) was associated with lower AF risk whereas higher dialysate bicarbonate concentrations (>35 vs. 35 mEq/l: incidence rate ratio = 3.18; 95% CI, 1.13–8.94) were associated with higher AF risk. Conclusion: New AF was detected in approximately one-third of patients with KF-HD. AF affects a substantial proportion of patient days and may be an underappreciated cause of stroke in KF-HD.

Published
2022
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3. Primary outcomes of the Monitoring in Dialysis Study indicate that clinically significant arrhythmias are common in hemodialysis patients and related to dialytic cycle

Author

Prabir Roy-Chaudhury, Jim A. Tumlin, Bruce A. Koplan, Alexandru I. Costea, Vijay Kher, Don Williamson, Saurabh Pokhariyal, David M. Charytan, James Tumlin, Vikranth Reddy, Kowdle Chandrasekhar Prakash, David Charytan, Suresh Chandra Tiwari, Amber Podoll, Sanjeev Jasuja, G. Leslie Walters, Kraig Wangsnes, Alexandru Costea, Selcuk Tombul, Balbir Singh, Brajesh Mishra, Sachin Yalagudri, Abhijeet Shelke, Calambur Narasimhan, A.M. Karthigesan, Abraham Oomman, K.P. Pramod Kumar, Bruce Koplan, Upendra Kaul, Tapan Ghose, Ripen Gupta, Arvind Sethi, Nikhil Kumar, Ramesh Hariharan, Rajnish Sardana, Arif Wahab, N.N. Khanna, Mark Smith, Suresh Kamath, Claude Galphin, Puneet Sodhi, Rajsekara Chakravarthy, Subba Rao Budithi, Finnian McCausland, Sanjeev Gulati, Munawer Dijoo, Upendra Singh, Salil Jain, Vishal Saxena, Gaurav Sagar, Rachel Fissell, Robert Foley, Charles A. Herzog, Peter McCullough, John D. Rogers, James A. Tumlin, Peter Zimetbaum, Manish Assar, Mark Kremers, and Wolfgang C. Winkelmayer

Subjects
Adult, Male, Bradycardia, medicine.medical_specialty, Time Factors, medicine.medical_treatment, 030232 urology & nephrology, India, 030204 cardiovascular system & hematology, Ventricular tachycardia, Risk Assessment, Sudden death, End stage renal disease, 03 medical and health sciences, 0302 clinical medicine, Heart Rate, Renal Dialysis, Risk Factors, Dialysis Solutions, Internal medicine, medicine, Humans, Prospective Studies, cardiovascular diseases, Asystole, Dialysis, Aged, business.industry, Incidence, Sodium, Arrhythmias, Cardiac, Atrial fibrillation, Middle Aged, medicine.disease, United States, Death, Sudden, Cardiac, Treatment Outcome, Nephrology, cardiovascular system, Cardiology, Kidney Failure, Chronic, Calcium, Female, Hemodialysis, medicine.symptom, business, Biomarkers
Abstract

Sudden death is one of the more frequent causes of death for hemodialysis patients, but the underlying mechanisms, contribution of arrhythmia, and associations with serum chemistries or the dialysis procedure are incompletely understood. To study this, implantable loop recorders were utilized for continuous cardiac rhythm monitoring to detect clinically significant arrhythmias including sustained ventricular tachycardia, bradycardia, asystole, or symptomatic arrhythmias in hemodialysis patients over six months. Serum chemistries were tested pre- and post-dialysis at least weekly. Dialysis procedure data were collected at every session. Associations with clinically significant arrhythmias were assessed using negative binomial regression modeling. Sixty-six patients were implanted and 1678 events were recorded in 44 patients. The majority were bradycardias (1461), with 14 episodes of asystole and only one of sustained ventricular tachycardia. Atrial fibrillation, although not defined as clinically significant arrhythmias, was detected in 41% of patients. With thrice-weekly dialysis, the rate was highest during the first dialysis session of the week and was increased during the last 12 hours of each inter-dialytic interval, particularly the long interval. Among serum and dialytic parameters, only higher pre-dialysis serum sodium and dialysate calcium over 2.5 mEq/L were independently associated with clinically significant arrhythmias. Thus, clinically significant arrhythmias are common in hemodialysis patients, and bradycardia and asystole rather than ventricular tachycardia may be key causes of sudden death in hemodialysis patients. Associations with the temporal pattern of dialysis suggest that modification of current dialysis practices could reduce the incidence of sudden death.

Published
2018

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