Characteristics of sudden death in hemodialysis patients

Abstract

Hemodialysis (HD) is an intermittent procedure during which large fluid and electrolyte shifts occur. We hypothesized that sudden death occurrences in HD patients are related to the timing of HD, and that they occur more frequently in the 12 h period starting with dialysis and in the 12 h period at the end of the dialysis-free weekend interval. In a retrospective study, 228 patient deaths were screened to determine if they met the criteria for sudden death. Information was obtained from clinic charts, dialysis center records, and interview of witnesses of the death event. There were 80 HD patients who met the criteria for sudden death. A bimodal distribution of death occurrences was present, with a 1.7-fold increased death risk occurring in the 12 h period starting with the dialysis procedure and a threefold increased risk of death in the 12 h before HD at the end of the weekend interval (P=0.011). Patients with sudden death had a high prevalence of congestive heart failure and coronary artery disease. Only 40% of patients experiencing sudden death were receiving beta-blockers, and the prior monthly serum potassium value was less than 4 mEq/l in 25%. Sudden death is temporally related to the HD procedure. Every other day HD could be beneficial in preventing sudden death. Careful attention to the usage of beta-blockers and to the maintenance of normal serum potassium values is indicated in HD patients at risk for sudden death.

The Challenge of Sudden Death in Dialysis Patients

“…Bleyer et al (32) observed that sudden death is particularly frequent hours after the start of dialysis on the one hand and during the hours preceding the next dialysis session on the other hand. Furthermore, sudden death is particularly frequent after the long weekend (33,34).…”

Predictors of Sudden Cardiac Death

“…Several studies have identified risk factors for SCD in HD patients, but few have compared predictors for SCD with other causes of death (2)(3)(4)(5)(6)(7)(8). The latter is important given that treatment recommendations may vary depending on the risk factor profile of the patient.…”

“…The US Renal Data System (USRDS) report attributes the single largest specific cause of death from cardiovascular disease to arrhythmias or cardiac arrest (1). Although certain risk factors associated with sudden cardiac death (SCD) in HD patients are similar to those in the general population, factors unique to kidney failure and the HD procedure play a prominent role but remain poorly understood (2)(3)(4)(5)(6)(7).…”

Clinical Implications of the Relationship between Low Calcium Concentration Dialysate and Sudden Death

“…However, sudden death and cardiac events are the most significant cause of mortality in the dialysis population. The increased risk of sudden death occurs at the end of the weekend interval immediately before dialysis or within 12 hours of the start of a dialysis session (6). Although the dialysate calcium concentration is unlikely to be a risk factor for deaths occurring at the end of the weekend interval, it could very well contribute to the large number of deaths and cardiac events occurring in the hours after the dialysis session.…”

“…Although the dialysate calcium concentration is unlikely to be a risk factor for deaths occurring at the end of the weekend interval, it could very well contribute to the large number of deaths and cardiac events occurring in the hours after the dialysis session. In a study from our center, approximately one-third of all sudden deaths occurred within 12 hours of the start of the dialysis treatment (6).…”