Cardiovascular diseases remain the primary leading cause of death in patients on maintenance hemodialysis accounting for nearly 41% of deaths.

Chronic kidney disease is associated with an excess of acquired arrhythmia of multiple types, and atrial fibrillation in particular.

Sudden cardiac death is also more common in chronic kidney disease and accounts for around one- quarter of deaths in dialysis patients.

The aim of the study is to evaluate the incidence, describe the patterns of cardiac arrhythmia and to determine the factors predisposing to cardiac arrhythmia in patients with chronic kidney disease with or without hemodialysis.

After obtaining written, informed consents, individuals are subjected to thorough clinical evaluation (age, sex, history of hypertension (HTN) or diabetes mellitus (DM)) and laboratory tests including complete blood count, urea, creatinine, glomerular filtration rate (eGFR) (calculated by CKD-EPI equation) , serum potassium, magnesium, calcium, phosphorus, parathyroid hormone (PTH), iron and total iron binding capacity (TIBC).

Twelve-lead ECG is performed and all ECGs are reviewed for the following parameters: heart rhythm, heart rate, frontal axis, P wave, PR interval, QRS duration, pathological Q wave, fragmented QRS morphology, ST-segment deviation, QT interval and T wave abnormality.

Inclusion Criteria:

• Patients with CKD (no intercurrent illness or uremic symptoms, and not hospitalized in the previous 3 months) with renal replacement therapy on maintenance HD (three times/week for at least three months) or without renal replacement therapy, aged 18 or above.

Exclusion Criteria:

• Patients aged <18 years old.
• Patients on drugs that are known to prolong the QT interval (e.g., antibiotics as clarithromycin, antifungal as fluconazole, antiarrhythmics as amiodarone, antipsychotic as chlorpromazine)
• Patients with structural heart diseases (e.g.,significant valvular lesions )
• Patients with impaired left ventricular systolic functions (defined as EF< 50%
• Patients with malignancy, severe infection or sepsis.
• Patients with major bleeding.

Patients with chronic kidney disease at hemodialysis unit and outpatient nephrology clinic at Sohag university hospitals