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 .
Cardiac disease is the major cause of death, accounting for approximately 40 percent of all-cause mortality in patients receiving either hemodialysis or peritoneal dialysis . 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) . (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" (SCD) 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)  (see "Overview of sudden cardiac arrest and sudden cardiac death"):