Ventricular arrhythmias in dialysis patients.

The occurrence of ventricular arrhythmias is common in renal failure patients who are receiving long-term hemodialysis. Associated ventricular arrhythmias may account for a major component of the cardiovascular mortality in hemodialysis patients. In the literature, a number of factors have been implicated in the genesis of these arrhythmias. Postulated theories range from hemodynamic alterations induced by dialysis, to metabolic alterations and derangements, to the molecular level of the current alterations in the L-type calcium channels of the heart. Studies have been conducted to ascertain whether testing, with signal-averaged electrocardiograms or electrophysiologic studies, can help to predict whether certain patients with renal failure might be more at risk for developing the complex arrhythmias noted in a large proportion of renal failure patients undergoing dialysis. This article examines the literature with regard to possible predictors in terms of patient characteristics, risk factors, electrophysiologic variables, and even dialysis method, all of which may play a part in determining the likelihood of a patient developing a ventricular arrhythmia.