Rastreio de fibrilação atrial subclínica entre os pacientes portadores de doença renal crônica dialítica usando um novo dispositivo portátil

Abstract

Introduction: Chronic kidney disease (CKD) is a public health problem worldwide. Hemodialysis is the main modality of renal replacement therapy with increasing incidence and prevalence. Hemodialysis patients have high cardiovascular morbidity and mortality, an increased prevalence of ventricular arrhythmias, sudden cardiac death and atrial fibrillation. The presence of atrial fibrillation (AF) is an independent risk factor for death and thromboembolic events in dialysis patients. However, the proper management of these patients remains uncertain. The prevalence of AF in dialytic patients is important for the correct understanding and adequate management of this arrhythmia. The use of a portable device would be a pioneer and probably more effective than traditional methods, since any trained professional can use it any time during hemodialysis. Objectives: This study aims to estimate the prevalence of subclinical AF among dialytic patients using a portable device. Methods: Dyalitic patients at Hospital Evangélico (Belo Horizonte, Minas Gerais) underwent screening for AF during hemodialysis sessions using the MyDiagnostick® portable device (Applied Biomedical Systems, Maastricht, Netherlands). Clinical, electrocardiographic factors and intradialytic changes were collected to assess possible associations. Results: 388 patients were included in the analysis. Female gender corresponded to 40.7% of the sample, mean age 58 years (± 14.7) and time on hemodialysis was 27 (IQR 10;57) months. A positive screening was found in 16 patients (4.1%). AF was confirmed in 7 patients (1.8%) using electrocardiogram. Male sex, older age, altered basal electrocardiogram, higher serum potassium, lower systolic arterial pressure and angina pectoris longer time on hemodialysis, presence of stable angina were more frequent in positive screenings. Serum potassium levels <6mEq / L, extrasystoles and intraventricular conduction disorder were associated with positive screening. The device showed specificity of 91.74%(95% CI 86,65% to 96,91), sensitivity of 100%(95% CI 100% to 100%), with 100% negative predictive value( 95% CI 100% to 100%). The positive likelihood ratio was 12.1(95% CI 6,5 to 22,6). Conclusion: The use of a portable device for AF screening proved to be practical, easy to handle, with high sensitivity and excellent negative predictive value. Further studies are needed to assess the prognostic implications of these results. Keywords: Subclinical atrial fibrillation. Chronic kidney disease. Hemodialysis screening.