Narrative ReviewSudden Cardiac Death in Hemodialysis Patients: An In-Depth Review
Section snippets
Epidemiology and Definition of SCD in Dialysis Patients
SCD is the unexpected natural death from a cardiac cause within 1 hour of onset of symptoms in a person not known to have a potentially fatal condition.3 In the general population, this occurs at a rate of ∼1 death/1,000 patient-years and accounts for 6%-13% of all deaths.4, 5 US Renal Data System (USRDS) reports include deaths from confirmed arrhythmia and deaths from cardiac arrest of unknown cause, but without specifying time frame or whether the death is of cardiac origin. These SCDs
Comparative Pathologic Processes of SCD in CKD Patients and the General Population
In the general population, up to 80% of SCD cases will have post mortem evidence of abnormal coronary vessels,10, 11 and those at highest risk of SCD are patients with heart failure. However, these pathologic processes do not appear to be as important in SCD events in dialysis patients. This section compares the underlying disease processes in SCD between dialysis patients and the general population.
Dialysis as a Risk Factor for SCD
With the exception of CKD itself, all previously described pathologic factors shown to predict SCD in dialysis patients are associated with SCD in the general population. Hence, it may be that the high SCD risk associated with dialysis reflects the relative prevalence of these factors rather than dialysis-specific SCD. However, there is evidence that the process of dialysis itself incurs an additional major risk, and this is discussed in the following section.
Hemodialysis patients die of
ICD Devices in Dialysis Patients
The most effective therapy for SCD in the general population is the use of ICD devices. This section discusses their use in dialysis patients. The current international guidelines for ICD implantation are listed in Box 2. A meta-analysis of 6 cohort studies65, 66, 67, 68, 69, 70, 71, 72 assessed the outcome of ICD therapy in patients with CKD according to conventional guidelines. This compared mortality between patients with and without ESRD. Dialysis patients had 2.7-fold higher mortality.25
Conclusion
Risk factors for sudden death in the general population also apply to people on dialysis therapy; however, the relative frequencies of these factors differ between the 2 groups. Furthermore, comparisons between dialysis patients and the general population are hindered by differences in definitions of SCD used. Even comparisons of studies of sudden death within nephrology are limited by the lack of a common term when classifying a death as sudden or unexpected.
CAD and heart failure, pre-eminent
Acknowledgements
Support: None.
Financial Disclosure: The authors declare that they have no relevant financial interests.
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Originally published online April 18, 2011.