Sudden Cardiac Death Among Hemodialysis Patients

Abstract

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.

The Incidence and Associated Factors of Sudden Death in Patients on Hemodialysis: 10-Year Outcome of the Q-Cohort Study

“…Patients on hemodialysis may be predisposed to various factors affecting the onset of sudden death compared with the general population 9) . Nevertheless, there have only been a few reports that evaluated risk factors of sudden death in patients undergoing hemodialysis [10][11][12] .…”

A Joint Evaluation of Neurohormone Vasopressin-Neurophysin II-Copeptin and Aortic Arch Calcification on Mortality Risks in Hemodialysis Patients

“…Why does VP interact with AAC to increase the risk of CV mortality? EOVC associated impaired vasodilation and luminal narrowing play pivotal roles in the pathophysiology of ischemic events and sudden cardiac death in MHD population (18), and AAC has been recognized as a potent indicator of EOVC (24). Zhang et al conducted a meta-analysis to prove that AAC predicts CV and all-cause mortality in dialysis population (24).…”

“…Physiologically, the primary determinant of the vasopressin system is a state of systemic hypoperfusion regardless of cardiac morphological determinants, including myocardial stretch, wall thickness or cavity dimensions (11)(12)(13)(14). Nonetheless, MHD patients are especially prone to extraosseous vascular calcification (EOVC) associated luminal narrowing (15), leading to systemic hypoperfusion, reduced vascular compliance, impaired myocardial perfusion, elevated cardiac afterload, left ventricular hypertrophy, and ultimately sudden cardiac death (16)(17)(18). With regard to the extremely high prevalence of EOVC in MHD population, emerging evidence have highlighted that surrogate markers of EOVC can independently predict mortality risks (19,20).…”

Impending challenges of the burden of end‐stage kidney disease in Australia

“…In 2017, the three most common causes of death for dialysis patients were withdrawal (32% of overall deaths), CVD (30%) and infection (10%); whereas for kidney transplant recipients, the three most common causes were cancer (25%), CVD (23%) and infection (14%) . A substantial proportion of CVD deaths are not directly related to complications of atherosclerotic CVD, but to an excess of sudden cardiac death . Even though patients with CKD and dialysis and transplant patients have an excess of traditional CVD risk factors, treatment strategies (such as statin therapy and erythropoietin) targeted against these risk factors have largely been ineffective or have only had a modest benefit .…”