Chronic kidney disease (CKD) is associated with a broader range of major arrhythmias than previously appreciated, according to new study findings.

Investigators reviewed results from 2 weeks of noninvasive, single-lead continuous electrocardiogram monitoring (using Zio Patch) of 2257 adults aged 71-94 years from the Atherosclerosis Risk in Communities study. Of these, 58% had stage 3 or higher CKD.

Among major arrhythmias, patients with CKD displayed nonsustained ventricular tachycardia (30.2%), atrial fibrillation (7.4%), pause longer than 30 seconds (2.7%), and atrioventricular block (1.8%), Kunihiro Matsushita, MD, of Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and colleagues reported in the Journal of the American Society of Nephrology. Nonsustained ventricular tachycardia was the most frequent major arrhythmia at 4.2 episodes per person-month. Minor arrhythmias were almost ubiquitous among patients with CKD, including supraventricular ectopy (99.9%), ventricular ectopy (98.8%), and supraventricular tachycardia (89.8%).

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Dr Matsushita’s team identified CKD using the CKD Epidemiology Collaboration equation for cystatin C-based estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR). In fully adjusted models, albuminuria was significantly associated with a 27% higher prevalence of atrial fibrillation and longer time in atrial fibrillation. Albuminuria also was significantly associated with a 7% higher prevalence of nonsustained ventricular tachycardia. Conversely, lower eGFR correlated with a lower frequency of atrioventricular block. No other significant relationship were found using eGFR.

“Using a novel 2-week monitoring approach, our study found a broader range of arrhythmias associated with CKD than previously reported,” the authors wrote.

Dr Matsushita’s team said their findings suggest that CKD is associated with a higher risk of ventricular arrhythmia of varying severity (ectopic beats to nonsustained tachycardia), which can explain the high burden of sudden cardiac death in CKD.


Kim ED, Soliman EZ, Coresh J, Matsushita K, Chen LY. Two-week burden of arrhythmias across CKD severity in a large community-based cohort: The ARIC study. J Am Soc Nephrol. 2021;32:629-638. doi:10.1681/ASN.2020030301