Evaluation of sudden cardiac arrest and sudden cardiac death in dialysis patients

OVERVIEW

Dialysis patients are at extraordinarily high risk for death. In 2008, the annual mortality rate for prevalent United States dialysis patients was 200 deaths/1000 patient-years [1].

Cardiac disease is the major cause of death, accounting for about 40 percent of all-cause mortality in patients receiving either hemodialysis or peritoneal dialysis [1]. In the United States Renal Data System (USRDS) database, the single largest specific cause of death is attributed to arrhythmic mechanisms or sudden cardiac arrest (SCA) [1]. (See "Patient survival and maintenance dialysis".)

The epidemiology, clinical manifestations, and evaluation of SCA and sudden cardiac death (SCD) in the dialysis population are provided in this topic review. Detailed discussions of treatment and prevention of SCA and SCD in dialysis patients and in patients without kidney disease are presented separately. (See "Treatment and prevention of sudden cardiac arrest in dialysis patients" and "Overview of sudden cardiac arrest and sudden cardiac death".)

DEFINITION AND EPIDEMIOLOGY

In the general population, the term "sudden cardiac death" is commonly used to describe sudden cardiac arrest (SCA) in the setting of heart disease (although some have structurally normal hearts) with cessation of cardiac function, whether or not resuscitation or spontaneous reversion occurs.

Previously, the term SCD has been used even if a patient were successfully resuscitated. Such cases have been referred to as "aborted SCD" or "resuscitated SCD," and patients who experienced such events were said to be "sudden death survivors." Clearer and more rational definitions of SCA and SCD were proposed in 2006 by the American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) [2] (see "Overview of sudden cardiac arrest and sudden cardiac death"):

        

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: Apr 2013. | This topic last updated: Jun 13, 2012.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. US Renal Data System: USRDS 2011 Annual Data Report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2011.
  2. American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (ACC/AHA/HRS Writing Committee to Develop Data Standards on Electrophysiology), Buxton AE, Calkins H, et al. ACC/AHA/HRS 2006 key data elements and definitions for electrophysiological studies and procedures: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (ACC/AHA/HRS Writing Committee to Develop Data Standards on Electrophysiology). Circulation 2006; 114:2534.
  3. US Renal Data System: USRDS 2006 Annual Data Report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2006.
  4. Herzog, CA. Sudden Cardiac Death in Dialysis Patients. http://www.usrds.org/presentations.htm (Accessed January 4, 2007).
  5. Cheung AK, Sarnak MJ, Yan G, et al. Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney Int 2004; 65:2380.
  6. Wanner C, Krane V, März W, et al. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 2005; 353:238.
  7. Parekh RS, Plantinga LC, Kao WH, et al. The association of sudden cardiac death with inflammation and other traditional risk factors. Kidney Int 2008; 74:1335.
  8. Jadoul M, Thumma J, Fuller DS, et al. Modifiable practices associated with sudden death among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Clin J Am Soc Nephrol 2012; 7:765.
  9. Rea TD, Pearce RM, Raghunathan TE, et al. Incidence of out-of-hospital cardiac arrest. Am J Cardiol 2004; 93:1455.
  10. Bleyer AJ, Russell GB, Satko SG. Sudden and cardiac death rates in hemodialysis patients. Kidney Int 1999; 55:1553.
  11. Bleyer AJ, Hartman J, Brannon PC, et al. Characteristics of sudden death in hemodialysis patients. Kidney Int 2006; 69:2268.
  12. Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med 2001; 345:1473.
  13. Spaulding CM, Joly LM, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med 1997; 336:1629.
  14. Shastri S, Tangri N, Tighiouart H, et al. Predictors of sudden cardiac death: a competing risk approach in the hemodialysis study. Clin J Am Soc Nephrol 2012; 7:123.
  15. Herzog, CA, Strief, J, Gilbertson, DT. Cause-specific mortality of dialysis patients after coronary revascularization: Why don't dialysis patients have better survival after coronary intervention? [Abstract]. Circulation Suppl 2004; 110:493.
  16. Herzog CA, Strief JW, Collins AJ, Gilbertson DT. Cause-specific mortality of dialysis patients after coronary revascularization: why don't dialysis patients have better survival after coronary intervention? Nephrol Dial Transplant 2008; 23:2629.
  17. U.S. Renal Data System: USRDS 2002 Annual Data Report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2002.
  18. Pun PH, Lehrich RW, Honeycutt EF, et al. Modifiable risk factors associated with sudden cardiac arrest within hemodialysis clinics. Kidney Int 2011; 79:218.
  19. Young BA. Prevention of sudden cardiac arrest in dialysis patients: can we do more to improve outcomes? Kidney Int 2011; 79:147.
  20. Mangrum, JM, Lin, D, Dimarco, J, et al. Prognostic value of left ventricular systolic function in renal dialysis patients [Abstract]. Heart Rhythm 2006; 3:S154.
  21. Zoccali C, Mallamaci F, Parlongo S, et al. Plasma norepinephrine predicts survival and incident cardiovascular events in patients with end-stage renal disease. Circulation 2002; 105:1354.
  22. Stenvinkel P. Inflammation in end-stage renal disease: the hidden enemy. Nephrology (Carlton) 2006; 11:36.
  23. Bellomo G, Lippi G, Saronio P, et al. Inflammation, infection and cardiovascular events in chronic hemodialysis patients: a prospective study. J Nephrol 2003; 16:245.
  24. Rodriguez-Benot A, Martin-Malo A, Alvarez-Lara MA, et al. Mild hyperphosphatemia and mortality in hemodialysis patients. Am J Kidney Dis 2005; 46:68.
  25. Packer M, Lee WH. Provocation of hyper- and hypokalemic sudden death during treatment with and withdrawal of converting-enzyme inhibition in severe chronic congestive heart failure. Am J Cardiol 1986; 57:347.
  26. Reiter MJ, Mann DE, Williams GR. Interaction of hypokalemia and ventricular dilatation in isolated rabbit hearts. Am J Physiol 1993; 265:H1544.
  27. Halperin BD, Adler SW, Mann DE, Reiter MJ. Mechanical correlates of contraction-excitation feedback during acute ventricular dilatation. Cardiovasc Res 1993; 27:1084.
  28. Chan KE, Lazarus JM, Hakim RM. Digoxin associates with mortality in ESRD. J Am Soc Nephrol 2010; 21:1550.
  29. Parfrey PS, Foley RN. The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol 1999; 10:1606.
  30. Mangrum, AJ, Lin, D, Dimarco, J. Sudden cardiac death and left ventricular function in hemodialysis patients [Abstract]. Heart Rhythm 2006; 2:S33.
  31. Yamada S, Ishii H, Takahashi H, et al. Prognostic value of reduced left ventricular ejection fraction at start of hemodialysis therapy on cardiovascular and all-cause mortality in end-stage renal disease patients. Clin J Am Soc Nephrol 2010; 5:1793.
  32. Ganesh SK, Stack AG, Levin NW, et al. Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 2001; 12:2131.
  33. Kruger A, Stewart J, Sahityani R, et al. Laser Doppler flowmetry detection of endothelial dysfunction in end-stage renal disease patients: correlation with cardiovascular risk. Kidney Int 2006; 70:157.
  34. Levin A, Singer J, Thompson CR, et al. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis 1996; 27:347.
  35. Lindner A, Charra B, Sherrard DJ, Scribner BH. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med 1974; 290:697.
  36. Mall G, Huther W, Schneider J, et al. Diffuse intermyocardiocytic fibrosis in uraemic patients. Nephrol Dial Transplant 1990; 5:39.
  37. Schietinger BJ, Brammer GM, Wang H, et al. Patterns of late gadolinium enhancement in chronic hemodialysis patients. JACC Cardiovasc Imaging 2008; 1:450.
  38. Friedman AN, Groh WJ, Das M. A pilot study in hemodialysis of an electrophysiological tool to measure sudden cardiac death risk. Clin Nephrol 2007; 68:159.
  39. Wang AY, Lam CW, Chan IH, et al. Sudden cardiac death in end-stage renal disease patients: a 5-year prospective analysis. Hypertension 2010; 56:210.
  40. K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 2005; 45:S1.
  41. Apple FS, Murakami MM, Pearce LA, Herzog CA. Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease. Circulation 2002; 106:2941.