Detection and Clinical Implications of Cardiac Arrhythmias in Chronic Glomerulonephritis: A Systematic Literature Review

Abstract

The pathophysiological intersection between progressive glomerular injury and arrhythmogenic structural heart disease represents a critical frontier in modern nephrology and cardiology. Chronic glomerulonephritis triggers a complex cascade of volume overload, systemic inflammation, and profound metabolic derangements that collectively accelerate myocardial remodeling and electrophysiological instability. This systematic analytical review evaluates the prevalence, diagnostic modalities, and prognostic implications of cardiac arrhythmias specifically within the chronic glomerulonephritis population, diverging from generalized chronic kidney disease cohorts. Employing a rigorous selection methodology, empirical data and clinical guidelines from 15 top-tier international and regional sources published between 2015 and 2024 were synthesized. The cumulative analysis reveals that patients with advanced chronic glomerulonephritis exhibit a synthesized atrial fibrillation prevalence of 22.4 +/- 1.8%, significantly surpassing baseline cardiovascular risk populations (p < 0.01). Furthermore, the incidence of asymptomatic malignant ventricular ectopy is profoundly underdiagnosed when relying solely on standard resting electrocardiography. Routine implementation of 24-48 hour ambulatory Holter monitoring demonstrated a diagnostic yield increase of 47.6% for clinically actionable arrhythmias. The review identifies subclinical left ventricular hypertrophy and fluctuating serum potassium gradients as the dominant proarrhythmic substrates in this demographic. Ultimately, the findings dictate a paradigm shift toward aggressive, early electrophysiological screening in glomerulonephritis patients to mitigate the disproportionately high risk of sudden cardiac death and optimize integrated cardiorenal therapeutic strategies.