Heart Rate Parameters for Holding Treatment in ESRD Patients

Treatment should be held if heart rate falls below 60 beats per minute or exceeds 100 beats per minute in ESRD patients. 1, 2

Heart Rate Thresholds for ESRD Patients

Heart rate is an important vital sign parameter that predicts outcomes in patients with ESRD, with both elevated resting heart rate and reduced heart rate variability associated with increased risk of ESRD-related hospitalizations 3
Lower threshold: Hold treatment if heart rate falls below 60 beats per minute, as this may indicate excessive bradycardia which can lead to hemodynamic compromise during dialysis 1, 2
Upper threshold: Hold treatment if heart rate exceeds 100 beats per minute, as tachycardia may indicate underlying cardiovascular stress, volume overload, or other acute conditions requiring assessment before proceeding with treatment 1, 2

For ESRD patients with concomitant heart failure, a persistent resting heart rate over 70 beats per minute despite optimal beta-blocker therapy may warrant additional heart rate control measures before proceeding with treatment 4
In patients receiving medications that affect heart rate (such as beta-blockers), treatment should be held if symptomatic bradycardia develops, regardless of the absolute heart rate value 2
For ESRD patients with atrial fibrillation, a higher threshold for holding treatment may be appropriate (heart rate >110 bpm) as rate control targets are typically less stringent 2

Heart rate should be measured before, during, and after dialysis sessions to identify trends that may predict adverse events 1
Ambulatory heart rate monitoring may provide additional information, with reference ranges for mean ambulatory heart rate being 57-90 bpm in men and 61-92 bpm in women 5
Heart rate variability measurements may provide additional risk stratification for ESRD patients, with lower variability associated with worse outcomes 3

For ESRD patients with diabetes, heart rate should be monitored more frequently as autonomic dysfunction may mask symptoms of hemodynamic compromise 4
In younger ESRD patients (particularly young black males who are at higher risk), more stringent heart rate monitoring is recommended due to their increased risk of cardiovascular complications 6
For patients on medications that affect heart rate (beta-blockers, calcium channel blockers, ivabradine), treatment parameters should be adjusted accordingly, with treatment held if heart rate falls below 55 bpm 4, 2

Heart rate parameters should be considered alongside blood pressure measurements, with treatment held if systolic blood pressure is <100 mmHg with concurrent bradycardia (<60 bpm) 1
For patients with heart failure and ESRD, the ideal heart rate may be calculated using the formula: ideal heart rate (bpm) = 93 - 0.13 × deceleration time (ms), based on echocardiographic parameters 7
When making decisions about holding treatment, the trend of heart rate changes may be more important than absolute values, particularly if the patient is asymptomatic 1, 2

Failing to distinguish between acute changes in heart rate versus chronic baseline abnormalities can lead to inappropriate treatment decisions 2
Not considering the effects of medications on heart rate parameters may result in unnecessary treatment holds 4, 2
Overlooking the importance of heart rate variability as a prognostic indicator in ESRD patients can miss opportunities for early intervention 3