Cardiac arrest and sudden death in dialysis units

Abstract

Cardiac arrest is a relatively infrequent but devastating complication of hemodialysis. To reduce the risk of adverse cardiac events on hemodialysis, the dialysate prescription should be evaluated and modified on an ongoing basis, especially following hospitalization in high-risk patients.

Predictors of Survival after Cardiac Arrest in Outpatient Hemodialysis Clinics

“…First, the study design might not allow for complete capture of relevant events. However, the incidence of CA as defined in our cohort is comparable to previously reported in-center CA rates (4,5). Second, although we controlled for many known factors that influence mortality in patients with ESRD, we acknowledge that other important known and potential covariates were not measured.…”

“…Patients with missing outcome data (n ϭ 15), as well as patients with documented "do not resuscitate" orders (n ϭ 53) on record were excluded from the analysis. Using this method, the overall rate of in-clinic CA was not substantially different from other published event rates for the hemodialysis population (4,5).…”

“…The single most common cause of death in patients who are maintained on hemodialysis is cardiac arrest (CA), which accounts for 61% of all cardiovascular mortality (2,3). Although many CA occur in unmonitored settings, intradialytic cardiac arrest in outpatient hemodialysis facilities is estimated to occur once for every 93 to 143 patientyears (4,5). This means that for the more than 3500 clinics in the United States, an average-sized clinic will likely need to treat a patient with CA roughly once each year (2).…”

“…A few conditions have been identified to be associated with CA in hemodialysis clinics (4), but surprisingly few studies have examined modifiable factors or therapies that are associated with survival after CA in this setting. It is plausible that poor outcomes after CA result from cardiovascular risk factors or from inadequate use of proven cardiovascular therapies in hemodialysis patients.…”

Predictors of Sudden Cardiac Death

“…Several studies have identified risk factors for SCD in HD patients, but few have compared predictors for SCD with other causes of death (2)(3)(4)(5)(6)(7)(8). The latter is important given that treatment recommendations may vary depending on the risk factor profile of the patient.…”