Sudden cardiac arrest in ESRD patients

Surana, Sikander P.; Pun, Patrick H.; Keithi-Reddy, Sai Ram; Spiegel, Steven M; Middleton, John; Singh, Ajay K.

doi:10.5414/cn107667

Cited by 5 publications

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sates Renal Data System [7]. SCA rate of uremic patients is higher than the rate recorded in subjects with any recognizable cardiac disease and general population (62 vs 5.98 vs 1.89/1,000 patient-year respectively) [8].…”

Section: 5% Of Prevalent Dialysis Patients Recorded In the Unitedmentioning

confidence: 99%

The Role of Implantable Cardioverter-Defibrillators in Prevention of Sudden Cardiac Arrest in Chronic Kidney Disease

Fabbian¹

2017

Arch Clin Nephrol

View full text Add to dashboard Cite

Sudden cardiac arrest (SCA) is defi ned as sudden, unexpected loss of heart function, breathing and consciousness, resulting from an electrical disturbance in the heart stopping its action and blood fl ow, and cardiovascular diseases are the major risk factors for SCA. It has been reported that more than 20% of all deaths in patients with advanced chronic kidney disease is due to arrhythmias and SCA [1].SCA is a malignant condition that could happen outof-hospital or in-hospital. A metanalysis published in 2010 evaluating more than 140,000 patients, showed that in patients suffering an out-of-hospital SCA survival to hospital admission was 23.8% and survival to hospital discharge 7.6% [2].Cooper, et al., analyzed more than 2,000 adult in-hospital cardiopulmonary resuscitation (CPR) attempts in a 1200bed general hospital in UK in order to provide survival rates and associated factors from a 10-year study. Immediate survival rate following CPR was 38.6%, 24.7% at 24 h, 15.9% at discharge, and 11.3% at 12 months. There were very low survival rates for pulse-less electrical activity and asystole compared to ventricular fi brillation, and survival rates were higher in patients aged less than 60 years [3].Cardiovascular diseases are a frequent complication of renal dysfunction and chronic kidney disease (CKD) and myocardial infarction and stroke have been reported to be risk factors for in-hospital mortality in these patients [4,5].Mortality of dialysis patients is high, in the fi rst year of hemodialysis, all-cause mortality was reported to be 421 deaths per 1,000 patient years after the second month of treatment, decreasing to 193 after one year of therapy. In the same way cardiovascular mortality was reported to peaked at 163 deaths per 1,000 patient years two months after treatment beginning, then to decrease to 79 after 12 months [6]. SCA is reported to be the most frequent cause of death in 24.3 of incident and 26.5% of prevalent dialysis patients recorded in the United Sates Renal Data System [7]. SCA rate of uremic patients is higher than the rate recorded in subjects with any recognizable cardiac disease and general population (62 vs 5.98 vs 1.89/1,000 patient-year respectively) [8]. Being SCA the most common cause of death in hemodialysis patients, Pun et al. investigated which factors improved survival after arrest, in their study from 2002 to 2005 evaluated 729 patients who suffered a SCA of whom 310 (42.5%) survived 24 hours, and 80 (11%) survived 6 months. Interestingly cardiovascular comorbidities, diabetes, hemoglobin, and dialysis adequacy, did not predict survival, on the contrary presence of indwelling catheter, and medications such as beta blockers (BBL), calcium-channel blockers (CCB), and angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) remained signifi cantly associated with survival (BBL odds ratio [OR] 0.32 [95% confi dence interval (CI) 0.17 to 0.61]; CCB OR 0.42 [95% CI 0.23 to 0.76]; ACEI/ARB OR 0.51 [95% CI 0.28 to 0.95]). Moreover prescription of BBL ...

show abstract

Section: 5% Of Prevalent Dialysis Patients Recorded In the Unitedmentioning

confidence: 99%

The Role of Implantable Cardioverter-Defibrillators in Prevention of Sudden Cardiac Arrest in Chronic Kidney Disease

Fabbian¹

2017

Arch Clin Nephrol

View full text Add to dashboard Cite

show abstract

“…Previous studies have shown that among patients with ESRD, cardiovascular disease is a major cause of morbidity and mortality 7. Cardiac arrest (CA) is common among these patients and carries high morbidity and mortality,8 9 especially in the intensive care unit (ICU) 10. Although CA is mostly attributed to coronary artery disease in the general population, ESRD-related CA may be mediated by additional mechanism,11 12 which have not yet been clearly defined.…”

Section: Introductionmentioning

confidence: 99%

Non-linear relationship between basal serum albumin concentration and cardiac arrest in critically ill patients with end-stage renal disease: a cross-sectional study

et al. 2022

View full text Add to dashboard Cite

ObjectivesThe aim of our study was to investigate the association between serum albumin concentration and the risk of cardiac arrest in critically ill patients with end-stage renal disease in the intensive care unit (ICU).DesignThis was a secondary analysis.SettingThe Phillip electronic-ICU collaborative database from 2014 to 2015.ParticipantsThis study included 4990 critically ill patients diagnosed with end-stage renal disease.Primary and secondary outcome measuresThe exposure of interest was serum albumin concentration. The outcome variable was cardiac arrest.ResultsA non-linear relationship was observed between serum albumin concentration and risk of cardiac arrest, with an inflection point of 3.26 g/dL after adjusting for potential confounders. The effect sizes and the CIs on the left and right sides of the inflection point were 0.88 (0.65 to 1.19) and 0.32 (0.16 to 0.64), respectively.ConclusionsWithin an albumin range of 3.26–5.6 g/dL, each 1 g/dL increase in serum levels is associated with a 68% decrease of the risk of cardiac arrest in critically ill patients with end-stage renal disease.

show abstract

Sudden cardiac death in CKD patients

Franczyk¹,

Gluba-Brzózka

Wranicz³

et al. 2015

Int Urol Nephrol

View full text Add to dashboard Cite

The risk of sudden cardiac death (SCD) is high in chronic kidney disease patients, and it increases with the progression of kidney function deterioration. The most common causes of SDC are the following: ventricular tachycardia, ventricular tachyarrhythmia, tachycardia torsade de pointes, sustained ventricular fibrillation and bradyarrhythmia. Dialysis influences cardiovascular system and results in hemodynamic disturbances as well as electrolyte shifts altering myocardial electrophysiology. Studies suggest that this procedure exerts both detrimental (poor volume control can exacerbate hypertension and left ventricle hypertrophy) and beneficial effects (associated with fluid removal and subsequent decrease in left ventricle stretch). Dialysis-related vulnerability to serious arrhythmias is the result of sudden shifts in fluid status and electrolytes, particularly potassium, which alter the physiological milieu. Also Ca(2+) ions, in which concentration alters during dialysis, are of key importance in the contraction of vascular smooth muscle cells and cardiac myocytes, thus exerting significant effects on hemodynamics. Due to the fact that SCD occurs with similar frequency in peritoneal dialysis and in hemodialysis patients, it seems that end-stage renal disease factors are more important than the specific ones associated with dialysis type. The results of randomized trials suggested that hemodialysis patients may not derive the same benefit of cardiovascular disease therapy including beta-blockers, calcium channel blockers and angiotensin-converting enzyme inhibitors as the general population with normal kidney function. Noninvasive tests used to stratify SCD risk in HD patients have poor positive value, and thus, combining tests including HRV, baroreceptor sensitivity and effectiveness index as well as its function indices and heart rate turbulence should be implemented. There are only few large randomized placebo-controlled trials assessing the influence of cardioprotective medications or implantable cardioverter defibrillator (ICD) implantation in dialysis patients on life quality and survival, and their results are sometimes contradictory. The decision concerning treatment and/or ICD implantation in this group of patients should be made on the basis of careful assessment of individual risk factors. Moreover, due to the high hazard of cardiovascular mortality including SCD in dialysis patients, physicians should concentrate on the early selection of high-risk patients, monitoring them and introduction of preventive measures.

show abstract

Sudden cardiac arrest in ESRD patients

Cited by 5 publications

References 0 publications

The Role of Implantable Cardioverter-Defibrillators in Prevention of Sudden Cardiac Arrest in Chronic Kidney Disease

The Role of Implantable Cardioverter-Defibrillators in Prevention of Sudden Cardiac Arrest in Chronic Kidney Disease

Non-linear relationship between basal serum albumin concentration and cardiac arrest in critically ill patients with end-stage renal disease: a cross-sectional study

Sudden cardiac death in CKD patients

Contact Info

Product

Resources

About