Sudden cardiac death in chronic kidney disease: epidemiology and prevention

Abstract

Annual cardiovascular mortality in patients with chronic kidney disease (CKD) is much higher than in the general population. The rate of sudden cardiac death increases as the stage of CKD increases and could be responsible for 60% of cardiac deaths in patients undergoing dialysis. In hemodialysis units treating patients with CKD, cardiac arrest occurs at a rate of seven arrests per 100,000 hemodialysis sessions. Important risk factors for sudden cardiac death in patients with CKD include hospitalization within the past 30 days, a drop of 30 mmHg in systolic blood pressure during hemodialysis, duration of life on hemodialysis, time since the previous dialysis session, and the presence of concomitant diabetes mellitus. As a result of the adverse cardiomyopathic and vasculopathic milieu in CKD, the occurrence of arrhythmias, conduction abnormalities, and sudden cardiac death could be exacerbated by electrolyte shifts, divalent ion abnormalities, diabetes, sympathetic overactivity, in addition to inflammation and perhaps iron deposition. Impaired baroreflex effectiveness and sensitivity, as well as obstructive sleep apnea, might also contribute to the risk of sudden death in CKD. The likelihood of survival following cardiac arrest is very low in dialysis patients. Primary and secondary prevention of cardiac arrest could reduce cardiovascular mortality in patients with CKD. Cardioverter-defibrillator implantation decreases the risk of sudden death in patients with CKD. The decision to implant a cardioverter-defibrillator should be influenced by the patient's age and stage of CKD.

Klotho and Phosphate Are Modulators of Pathologic Uremic Cardiac Remodeling

“…49 Fibrosis also interrupts electrical signals, 50 rendering the tissue more arrhythmogenic, which is highly prevalent in the CKD population. 12,51,52 Phosphotoxicity is a risk factor for progression of kidney disease and cardiovascular disease in CKD/ESRD, but causality has not been established. 24,[53][54][55] In rodents with normal renal function, long-term high-phosphate intake induced cardiac remodeling and was associated with decreased renal and systemic Klotho (Figure 4) and increased plasma PTH and FGF23 (Supplemental Table 1).…”

Implantable loop recorders in patients with unexplained syncope: Clinical predictors of pacemaker implantation

“…Chronic kidney disease has been shown to be a risk factor of sudden cardiac death caused by cardiomyopathy, myocardial inflammation, myocardial fibrosis, arrhythmias and conduction abnormalities [17,18]. Sudden cardiac death in patients with chronic renal failure is associated with increased levels of inflammatory markers such as high-sensitivity C-reactive protein and interleukin 6 which are both linked to fibrotic changes of the myocardium and the electrical conduction system itself [19].…”

Near-Term Prediction of Sudden Cardiac Death in Older Hemodialysis Patients Using Electronic Health Records

“…Cardiac disease accounts for 43% of all-cause mortality, with approximately 61% of those deaths caused by sudden cardiac arrest (SCA) (1). Significant work has been undertaken to understand the epidemiology of and identify risk factors for SCA (2)(3)(4)(5)(6)(7)(8)(9)(10). Many of the risk factors identified, including lower ultrafilitration volume, low calcium dialysate, and shorter treatment time, are readily captured by electronic health record (EHR) systems.…”