Cardiac Arrhythmia and Hypoglycaemia Among Individuals with and Without Diabetes Receiving Haemodialysis (the CADDY Study): a Danish Multicentre Cohort Study

Overview

Journal Diabetologia

Specialty Endocrinology

Date 2025 Feb 28

PMID 40019498

Authors

Dea H Kofod

Soren Z Diederichsen

Tobias Bomholt

Mads O Andersen

Andreas Andersen

Ebba Mannheimer

Marianne Rix

Ylian S Liem

Kristine Lindhard

Henrik P Hansen

Casper Rydahl

Morten Lindhardt

Julie Brosen

Kristine Schandorff

Theis Lange

Kirsten Norgaard

Thomas P Almdal

Jesper H Svendsen

Bo Feldt-Rasmussen

Mads Hornum

Affiliations

Soon will be listed here.

Abstract

Aims/hypothesis: We aimed to examine arrhythmias and hypoglycaemia among individuals with and without diabetes who are receiving haemodialysis and to investigate the association between arrhythmias and hypoglycaemia, hyperglycaemia and glycaemic variability.

Methods: This prospective multicentre cohort study included 70 participants on maintenance haemodialysis (35 with diabetes and 35 without diabetes). We employed implantable cardiac monitors for continuous heart rhythm monitoring in combination with periodic use of continuous glucose monitoring. Logistic-regression-type linear mixed models were used to examine associations between arrhythmias and glycaemic measures.

Results: During 18 months of follow-up, clinically significant arrhythmias (bradyarrhythmia and ventricular tachycardia) were identified in 12 (34%) participants with diabetes and 11 (31%) without diabetes. Atrial fibrillation was detected in 13 (37%) participants with diabetes and 14 (40%) without, while other supraventricular tachycardia was detected in seven (20%) and 11 (31%) participants with and without diabetes, respectively. Hypoglycaemia (sensor glucose <3.9 mmol/l) was observed in 27 (77%) participants with diabetes and 32 (91%) without diabetes. Compared with euglycaemia, hypoglycaemia was associated with an increased rate of arrhythmias among participants without diabetes (incidence rate ratio [IRR] 3.13 [95% CI 1.49, 6.55]), while hyperglycaemia (sensor glucose >10.0 mmol/l) was associated with a decreased rate of arrhythmias among participants with diabetes (IRR 0.58 [95% CI 0.37, 0.92]). Glycaemic variability showed no association with arrhythmias regardless of the presence of diabetes.

Conclusions/interpretation: Arrhythmias and hypoglycaemia were common in those undergoing haemodialysis regardless of diabetes status. Our data suggest a temporal relationship between arrhythmias and glucose level in both individuals with and without diabetes.

Trial Registration: Clinicaltrials.gov: NCT04841304.

References

Roberts P, Stromberg K, Johnson L, Wiles B, Mavrakanas T, Charytan D . A Systematic Review of the Incidence of Arrhythmias in Hemodialysis Patients Undergoing Long-Term Monitoring With Implantable Loop Recorders. Kidney Int Rep. 2021; 6(1):56-65. PMC: 7783576. DOI: 10.1016/j.ekir.2020.10.020. View

Samanta R, Chan C, Chauhan V . Arrhythmias and Sudden Cardiac Death in End Stage Renal Disease: Epidemiology, Risk Factors, and Management. Can J Cardiol. 2019; 35(9):1228-1240. DOI: 10.1016/j.cjca.2019.05.005. View

Cozzolino M, Mangano M, Stucchi A, Ciceri P, Conte F, Galassi A . Cardiovascular disease in dialysis patients. Nephrol Dial Transplant. 2018; 33(suppl_3):iii28-iii34. PMC: 6168816. DOI: 10.1093/ndt/gfy174. View

Palsson R, Patel U . Cardiovascular complications of diabetic kidney disease. Adv Chronic Kidney Dis. 2014; 21(3):273-80. PMC: 4045477. DOI: 10.1053/j.ackd.2014.03.003. View

Chow E, Bernjak A, Walkinshaw E, Lubina-Solomon A, Freeman J, Macdonald I . Cardiac Autonomic Regulation and Repolarization During Acute Experimental Hypoglycemia in Type 2 Diabetes. Diabetes. 2017; 66(5):1322-1333. PMC: 5860266. DOI: 10.2337/db16-1310. View

Robinson R, Harris N, Ireland R, Lee S, Newman C, Heller S . Mechanisms of abnormal cardiac repolarization during insulin-induced hypoglycemia. Diabetes. 2003; 52(6):1469-74. DOI: 10.2337/diabetes.52.6.1469. View

Andreasen C, Andersen A, Hagelqvist P, Maytham K, Lauritsen J, Engberg S . Sustained heart rate-corrected QT prolongation during recovery from hypoglycaemia in people with type 1 diabetes, independently of recovery to hyperglycaemia or euglycaemia. Diabetes Obes Metab. 2023; 25(6):1566-1575. DOI: 10.1111/dom.15005. View

Chow E, Bernjak A, Williams S, Fawdry R, Hibbert S, Freeman J . Risk of cardiac arrhythmias during hypoglycemia in patients with type 2 diabetes and cardiovascular risk. Diabetes. 2014; 63(5):1738-47. DOI: 10.2337/db13-0468. View

Novodvorsky P, Bernjak A, Chow E, Iqbal A, Sellors L, Williams S . Diurnal Differences in Risk of Cardiac Arrhythmias During Spontaneous Hypoglycemia in Young People With Type 1 Diabetes. Diabetes Care. 2017; 40(5):655-662. DOI: 10.2337/dc16-2177. View

10.

Pistrosch F, Ganz X, Bornstein S, Birkenfeld A, Henkel E, Hanefeld M . Risk of and risk factors for hypoglycemia and associated arrhythmias in patients with type 2 diabetes and cardiovascular disease: a cohort study under real-world conditions. Acta Diabetol. 2015; 52(5):889-95. DOI: 10.1007/s00592-015-0727-y. View

11.

Andersen A, Bagger J, Sorensen S, Baldassarre M, Pedersen-Bjergaard U, Forman J . Associations of hypoglycemia, glycemic variability and risk of cardiac arrhythmias in insulin-treated patients with type 2 diabetes: a prospective, observational study. Cardiovasc Diabetol. 2021; 20(1):241. PMC: 8710000. DOI: 10.1186/s12933-021-01425-0. View

12.

Hagelqvist P, Andersen A, Maytham K, Andreasen C, Engberg S, Lindhardt T . Glycaemia and cardiac arrhythmias in people with type 1 diabetes: A prospective observational study. Diabetes Obes Metab. 2023; 25(8):2300-2309. DOI: 10.1111/dom.15108. View

13.

Salenger P . Sudden Cardiac Death in End-Stage Renal Disease. Cardiol Clin. 2019; 37(3):319-326. DOI: 10.1016/j.ccl.2019.04.010. View

14.

Genovesi S, Boriani G, Covic A, Vernooij R, Combe C, Burlacu A . Sudden cardiac death in dialysis patients: different causes and management strategies. Nephrol Dial Transplant. 2019; 36(3):396-405. DOI: 10.1093/ndt/gfz182. View

15.

Galindo R, Beck R, Scioscia M, Umpierrez G, Tuttle K . Glycemic Monitoring and Management in Advanced Chronic Kidney Disease. Endocr Rev. 2020; 41(5). PMC: 7366347. DOI: 10.1210/endrev/bnaa017. View

16.

Galindo R, Soliman D, Chernavvsky D, Rhee C . Diabetes technology in people with diabetes and advanced chronic kidney disease. Diabetologia. 2024; 67(10):2129-2142. PMC: 11446991. DOI: 10.1007/s00125-024-06244-y. View

17.

Battelino T, Alexander C, Amiel S, Arreaza-Rubin G, Beck R, Bergenstal R . Continuous glucose monitoring and metrics for clinical trials: an international consensus statement. Lancet Diabetes Endocrinol. 2022; 11(1):42-57. DOI: 10.1016/S2213-8587(22)00319-9. View

18.

Roy-Chaudhury P, Tumlin J, Koplan B, Costea A, Kher V, Williamson D . Primary outcomes of the Monitoring in Dialysis Study indicate that clinically significant arrhythmias are common in hemodialysis patients and related to dialytic cycle. Kidney Int. 2018; 93(4):941-951. DOI: 10.1016/j.kint.2017.11.019. View

19.

Sacher F, Jesel L, Borni-Duval C, de Precigout V, Lavainne F, Bourdenx J . Cardiac Rhythm Disturbances in Hemodialysis Patients: Early Detection Using an Implantable Loop Recorder and Correlation With Biological and Dialysis Parameters. JACC Clin Electrophysiol. 2018; 4(3):397-408. DOI: 10.1016/j.jacep.2017.08.002. View

20.

Svendsen J, Diederichsen S, Hojberg S, Krieger D, Graff C, Kronborg C . Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial. Lancet. 2021; 398(10310):1507-1516. DOI: 10.1016/S0140-6736(21)01698-6. View