Heritability of Risk for Sudden Cardiac Arrest in ESRD

Chan, Kee; Newton‐Cheh, Christopher; Gusella, James F.; Maddux, Franklin W.

doi:10.1681/asn.2014090881

Cited by 9 publications

(8 citation statements)

References 18 publications

(20 reference statements)

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“…Multiple prior high-quality publications have resulted from the FMCNA database used in this study. 30,31 Approximately 35% of the United States adult outpatient dialysis population is represented in the FMCNA database. The Clinical Quality Group and Data Entry Error Reduction Task Force at FMCNA mandates protocols and audits incoming information to ensure data are accurately documented for clinical care and Medicare billing.…”

Section: Study Patientsmentioning

confidence: 99%

A Nationally Representative Study of Calcific Uremic Arteriolopathy Risk Factors

Nigwekar

Zhao

Wenger

et al. 2016

JASN

Self Cite

186

173

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Accurate identification of risk factors for calcific uremic arteriolopathy (CUA) is necessary to develop preventive strategies for this morbid disease. We investigated whether baseline factors recorded at hemodialysis initiation would identify patients at risk for future CUA in a matched case-control study using data from a large dialysis organization. Hemodialysis patients with newly diagnosed CUA (n=1030) between January 1, 2010, and December 31, 2014, were matched by age, sex, and race in a 1:2 ratio to hemodialysis patients without CUA (n=2060). Mean ages for patients and controls were 54 and 55 years, respectively; 67% of participants were women and 49% were white. Median duration between hemodialysis initiation and subsequent CUA development was 925 days (interquartile range, 273-2185 days). In multivariable conditional logistic regression analyses, diabetes mellitus; higher body mass index; higher levels of serum calcium, phosphorous, and parathyroid hormone; and nutritional vitamin D, cinacalcet, and warfarin treatments were associated with increased odds of subsequent CUA development. Compared with patients with diabetes receiving no insulin injections, those receiving insulin injections had a dose-response increase in the odds of CUA involving lower abdomen and/or upper thigh areas (odds ratio, 1.49; 95% confidence interval, 1.03 to 2.51 for one or two injections per day; odds ratio, 1.88; 95% confidence interval, 1.30 to 3.43 for 3 injections per day; odds ratio, 3.74; 95% confidence interval, 2.28 to 6.25 for more than three injections per day), suggesting a dose-effect relationship between recurrent skin trauma and CUA risk. The presence of risk factors months to years before CUA development observed in this study will direct the design of preventive strategies and inform CUA pathobiology.

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Section: Study Patientsmentioning

confidence: 99%

A Nationally Representative Study of Calcific Uremic Arteriolopathy Risk Factors

Nigwekar

Zhao

Wenger

et al. 2016

JASN

Self Cite

186

173

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“…A study examining SCD risk among related pairs of dialysis patients found a 70% increased risk of SCD if one relative suffered sudden cardiac death, compared to non-genetically related cohabitating dialysis pairs. 43 Specific genetic loci underlying the increased SCD risk among genetically related hemodialysis patients are unknown, but common variants in loci encoding cardiac ion channels may be involved. 44 Further investigations could identify novel SCD pathways and lead to better identification of those highest at risk for SCD.…”

Section: Pathophysiology Of Scdmentioning

confidence: 99%

Sudden Cardiac Death Among Hemodialysis Patients

Makar

Pun

2017

American Journal of Kidney Diseases

118

102

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Hemodialysis patients carry a large burden of cardiovascular disease; most onerous is the high risk of sudden cardiac death. Defining sudden cardiac death among hemodialysis patients as well as understanding its pathogenesis is challenging, but inferences from existing literature reveal differences between sudden cardiac death among hemodialysis patients and the general population. Vascular calcifications and left ventricular hypertrophy may play a role in the pathophysiology of sudden cardiac death whereas traditional cardiovascular risk factors seem to have a more muted effect. Arrhythmic triggers also differ in this group as compared to the general population, with some arising uniquely from the hemodialysis procedure. Combined, these factors may alter the types of terminal arrhythmias that lead to sudden cardiac death among hemodialysis patients, having important implications for prevention strategies. This review highlights current knowledge on the epidemiology, pathophysiology, and risk factors for sudden cardiac death among hemodialysis patients. We then examine strategies for prevention including use of specific cardiac medications and device-based therapies such as implantable defibrillators. We also discuss dialysis-specific prevention strategies including minimizing exposure to low potassium and calcium dialysate, extending dialysis treatment times or adding sessions to avoid rapid ultrafiltration, and lowering dialysate temperature.

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“…Additionally (but perhaps not surprisingly), there may be heritability to SCD propensity in dialysis patients. Chan et al recently reported that genetically related family members on dialysis had a 1.7-fold increase in the odds of cardiac arrest compared with matched, unrelated controls (9). In the general population, rare mutations in ionic channels cause several distinct long-QT syndromes, which are associated with a markedly higher risk of SCD (10).…”

Section: Scdmentioning

confidence: 99%

Arrhythmia and Sudden Death in Hemodialysis Patients

Charytan

Foley

McCullough

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background Dialysis patients have high rates of cardiovascular morbidity and mortality, but data on arrhythmia burden, arrhythmia type, arrhythmia triggers, and the identity of terminal arrhythmias have historically been limited by an inability to monitor heart rhythm for prolonged periods.Objectives To investigate arrhythmia and its association with sudden death in dialysis-dependent ESRD, describe the potential for implantable devices to advance study of dialysis physiology, review the ethical implications of using implantable devices in clinical studies, and report on the protocol and baseline results of the Monitoring in Dialysis Study (MiD).Design, setting, participants, & measurements In this multicenter, interventional-observational, prospective cohort study, we placed implantable loop recorders in patients undergoing long-term hemodialysis. The proportion of patients experiencing clinically significant arrhythmias was the primary endpoint. For 6 months, we captured detailed data on the primary endpoint, symptomatic arrhythmias, other electrocardiographic variables, dialysis prescription, electrolytes, dialysis-related variables, and vital signs. We collected additional electrocardiographic data for up to 1 year.Results Overall, 66 patients underwent implantation in sites in the United States and India. Diabetes was present in 63.6% of patients, 12.1% were age $70 years, 69.7% were men, and 53.0% were black. Primary and secondary endpoint data are expected in 2016.Conclusions Cardiac arrhythmia is an important contributor to cardiovascular morbidity and mortality in dialysis patients, but available technology has previously limited the ability to estimate its true burden and triggers and to define terminal rhythms in sudden death. Use of implantable technology in observational studies raises complex issues but may greatly expand understanding of dialysis physiology. The use of implantable loop recorders in MiD is among the first examples of such a trial, and the results are expected to provide novel insights into the nature of arrhythmia in hemodialysis patients.

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Heritability of Risk for Sudden Cardiac Arrest in ESRD

Cited by 9 publications

References 18 publications

A Nationally Representative Study of Calcific Uremic Arteriolopathy Risk Factors

A Nationally Representative Study of Calcific Uremic Arteriolopathy Risk Factors

Sudden Cardiac Death Among Hemodialysis Patients

Arrhythmia and Sudden Death in Hemodialysis Patients

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