Iatrogenic Hypothermia during Hemodialysis Can Induce Serious Cardiac Arrhythmias in Diabetic Patient

Cardiovascular diseases are the main cause of morbidity and mortality in end-stage renal disease (ESRD) patients. Cardiac arrhythmias are prevalent in patients undergoing hemodialysis (HD), however, dialysis treatment per se can be considered as an arrhythmogenic stimulus. Uremic patients are characterized by a "pro-arrhythmic substrate" because of the high prevalence of ischemic heart disease, left ventricular hypertrophy, and autonomic neuropathy. The incidence of hypothermia in HD patient is unknown. The severity of hypothermia correlated to cardiac arrhythmias. Here, we report a 50-year-old Saudi lady known case of long-standing diabetes mellitus with diabetic retinopathy, nephropathy and neuropathy, ESRD on HD, coronary artery disease developed transient third-degree heart block secondary to iatrogenic hypothermia during HD session, which was completely resolved after adjusting temperature of dialysis machine. To the best of our knowledge, the association of third-degree atrioventricular block and hypothermia induced by HD session has not been previously reported.