Risk Stratification of End Stage Renal Disease patients: continuous 48-hour 12-lead high-resolution ECG during and after hemodialysis session
Database:E-HOL-12-0051-016

CP2

End Stage Renal Disease (ESRD) is a costly and disabling condition that disproportionately affects racial/ethnic minority populations and is associated with a high mortality rate (230 per 1000 patients/year). The number of ESRD patients has increased at an average yearly rate of 3-4% between 1996 and 2005 in the United States. In 2000, there were ~281,000 US dialysis patients, and the projection forecasted ~520,000 dialysis patients in 2010. Today, there are approximately half a million people in the US with ESRD on hemodialysis and the annual mortality rate among these patients is close to 25%. Cardiac disease is implicated in as many as 44% of these deaths. Amongst those, cardiac arrhythmias represent 61% of all cardiac deaths.

Several prospective multicenter trials (MADIT I/II, AVID, CASH and CIDS) have demonstrated the benefit of ICD therapy for the reduction of sudden cardiac death (SCD) in high risk patients. A meta-analysis of three trials suggested better survival with ICDs with a 28% reduction of risk (p<0.0006). Unfortunately, dialysis patients were, in general, excluded from the large randomized trials. Retrospective studies suggested important benefits of ICDs in dialysis patients. Based on a group of 5,582 patients with acute myocardial infarction in which 460 dialysis patients (~8%) were implanted with ICDs, Herzog et al. reported a 42% reduction in cardiac risk. The study also emphasized the underutilization of the ICDs in this population. This observation was consistent with the results from Voigt et al. in 2004 describing ICD implantation in a group of survivors of cardiac arrest between 1996 and 2001: 31% were implanted whereas only 18% of dialysis patients surviving cardiac arrest received an ICD. Because the dialysis patients are at high risk for SCD, it is not surprising that most studies emphasize that these patients have the most to gain from receiving life-saving ICD therapies. At present, there are no specific clinical guidelines for the prescription of ICDs in ESRD patients and clinicians need risk- stratification methods to alter the abysmal outcome these patients are facing.

The Telemetric and Holter ECG Warehouse has added a new set of continuous 48-hour high-definition (1000Hz) ECG recordings acquired in ESRD patients in order to provide the opportunity to scientists to investigate whether there is information in the surface ECGs that could help better identify the high-risk patients with ESRD. Thirteen months follow up on a set of 51 patients recorded during hemodialysis and for a period of two days are available. Eleven patients died during the study follow up.

To learn more about this new dataset click here.

Accessing the data from the THEW

You can download a version of the THEW ECG viewer and download examples of Holter ECGs from our repository. Or you can become member to gain access to the data from our repository here.

About Us

The Steering Committee(SC) of the Telemetric and Holter ECG Warehouse (THEW) has been formed during the second quarter 2008, the eight individuals in the SC are from the National Health Institute, the Center for Drug Evaluation and Research, the Commissioner Office of the Food and Drug Administration (FDA) and the University of Rochester Medical Center. Read more about our team.


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