Predictors of Survival after Cardiac Arrest in Outpatient Hemodialysis Clinics

Pun, Patrick H.; Lehrich, Ruediger W.; Smith, Stephen R.; Middleton, John

doi:10.2215/cjn.02360706

Cited by 109 publications

(104 citation statements)

References 34 publications

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“…Of these 22 studies, 14 studies were excluded for the following reasons: duplicate data in 4 studies; there were 3 studies concerning renal outcomes but no ESRD or all-cause mortality [12][13][14] ; two studies were not randomized controlled trials 15,16 ; all the participants in two studies were hemodialysis patients 17,18 ; one study was about the survival only in kidney transplant patients 19 ; the number of participants in two trials was less than 100 20,21 ; Totally, eight studies were therefore included in this meta-analysis.…”

Section: Study Selectionmentioning

confidence: 99%

Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

Zhao

Liu³

et al. 2016

Renal Failure

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(2016) Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis, Renal Failure, 38:6,[849][850][851][852][853][854][855][856] Background:The renoprotective effect of inhibitors of renin-angiotensin system (RAS) has been identified through placebo-controlled trials. However, the effect of calcium-channel blockers (CCBs) on renal system is still controversial. Our current meta-analysis includes available evidences to compare the effect of dihydropyridine CCBs and ACEIs or ARBs on renal outcomes and mortality. We also further investigate whether CCBs can be used in combination with inhibitors of RAS to improve the prognosis of patients with chronic kidney disease (CKD). Methods and results: Electronic databases were searched up to July 2012, for clinical randomized controlled trials, assessing the effect of dihydropyridine CCBs on the incidence of end-stage renal disease (ESRD) and all-cause mortality in contrast to ACEIs or ARBs. Eight clinical trials were included containing 25,647 participants. ESRD showed significantly higher frequency with CCBs therapy compared with ACEIs or ARBs therapy, though blood pressure was decreased similarly in both groups in every trial (OR, 1.25; 95% CI, 1.05-1.48; p ¼ 0.01). In contrast, there was no significant difference in the incidence of all-cause mortality between these two groups, though ACEIs or ARBs exhibited better renoprotective effect compared to CCBs (OR, 0.96; 95% CI, 0.89-1.03; p ¼ 0.24). Conclusions: CCBs did not increase all-cause mortality incidence in patients with CKD though they displayed weaker renoprotective, compared to ACEIs or ARBs therapy. Our results suggest the combination of a CCB and an ACEI or ARB should be a preferable antihypertensive therapy in patients with CKD, considering their higher effect in decreasing blood pressure and fewer adverse metabolic problems caused.

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Section: Study Selectionmentioning

confidence: 99%

Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

Zhao

Liu³

et al. 2016

Renal Failure

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“…Because all deaths were directly witnessed (either in the dialysis clinic or on arrival at the hospital setting), it is unclear how the refined SCD definition performs in incidents of SCD that are either unwitnessed or occur outside of healthcare facilities. However, previous reports suggest that a significant proportion (11%-18%) of sudden cardiac arrest events in hemodialysis patients occur within outpatient dialysis clinics (9,10,12,21). Importantly, utilizing witnessed sudden cardiac arrest events afforded us greater confidence in the reliability of our SCD adjudication, which was central to the purpose of this study.…”

Section: Discussionmentioning

confidence: 90%

“…We chose to include only eyewitnessed cardiac arrest events to ensure accurate capture of SCD events and because a significant proportion of all SCD in hemodialysis patients occur within dialysis facilities (10)(11)(12). We defined sudden cardiac arrest events as the occurrence of a witnessed sudden pulseless condition in the outpatient dialysis setting that is not clearly attributable to a noncardiac cause.…”

Section: Study Cohortmentioning

confidence: 99%

Improving Ascertainment of Sudden Cardiac Death in Patients with End Stage Renal Disease

Pun

Herzog

Middleton

2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Data collected by the US Renal Data System (USRDS) identify sudden cardiac death (SCD) as the leading cause of death among hemodialysis patients. However, evidence suggests that clinical events captured on the USRDS death notification form may be inaccurate. A new method for classifying SCD was recently developed to enhance the accuracy of SCD classification. This study examined the performance characteristics of this refined definition using a cohort of hemodialysis patients who experienced a witnessed SCD as the reference standard.Design, setting, participants, & measurements This is a retrospective cohort study of 363 patients who experienced a witnessed SCD in US Gambro (DaVita) outpatient dialysis clinics. Sensitivity of SCD defined by death notification forms and SCD defined using additional administrative sources was compared. Clinical data recorded near time of death were also examined.Results Existing USRDS death notification forms reported 70.8% of witnessed SCD as "cardiac arrest/cause unknown" or "arrhythmia." The refined definition significantly improved identification to 83.8% of witnessed SCD events (P,0.001). Verified SCD cases that were not identified by either definition were more likely to be reported on the death notification form as death due to myocardial infarction, hyperkalemia, sepsis, malignancy, or unknown cause.Conclusions Compared with the death notification form alone, the refined SCD definition significantly improves the sensitivity of reporting of witnessed SCD occurring within outpatient hemodialysis clinics. More accurate reporting of cardiac events by clinicians and refinements to existing death notification forms may further improve recognition and understanding of SCD.

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“…A brace of interesting papers by Middleton and colleagues (15,16) focuses on a special minority of potentially preventable sudden cardiac deaths: cardiac arrest occurring in outpatient hemodialysis clinics. Lehrich et al (15) provide a pessimistic view of the utility of on-site automatic external defibrillators (AEDs) in dialysis centers, reporting a 1-yr Kaplan-Meier survival estimate of 9.5% after cardiac arrest in Gambro centers with AEDs on-site (n ϭ 237 patients in 140 clinics) and 7.8% in sites without AEDs (n ϭ 492 patients in 254 clinics).…”

mentioning

confidence: 99%

“…After adjustment for baseline differences, including medical therapy, the authors found no association with survival and on-site availability of AEDs. In this issue of CJASN, Pun et al (16), concentrating on the comparison of 24-h and 6-month survivors and nonsurvivors of cardiac arrest in the same 729-patient cohort, link ␤-blocker therapy to better immediate and long-term survival, and angiotensin-converting enzyme inhibitor or therapy with angiotensin receptor blockers and calcium-channel blockers to better long-term survival in a multivariate model.…”

mentioning

confidence: 99%

Can We Prevent Sudden Cardiac Death in Dialysis Patients?

Herzog

2007

Clinical Journal of the American Society of Nephrology

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Predictors of Survival after Cardiac Arrest in Outpatient Hemodialysis Clinics

Cited by 109 publications

References 34 publications

Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

Effect of calcium channels blockers and inhibitors of the renin-angiotensin system on renal outcomes and mortality in patients suffering from chronic kidney disease: systematic review and meta-analysis

Improving Ascertainment of Sudden Cardiac Death in Patients with End Stage Renal Disease

Can We Prevent Sudden Cardiac Death in Dialysis Patients?

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