CKD and Sudden Cardiac Death

Whitman, Isaac R.; Feldman, Harold I.; Deo, Rajat

doi:10.1681/asn.2012010037

Cited by 118 publications

(96 citation statements)

References 107 publications

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“…22 Some evidence of regional/ethnic variation exists. For example, the estimated proportion of SCD deaths among Japanese dialysis patients appears lower than in Western dialysis patients.…”

Section: A B D Cmentioning

confidence: 99%

Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

2016

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Abstract-Patients with chronic kidney disease and end-stage renal disease are at 5-to 10-fold higher risk for developing cardiovascular disease (CVD) than age-matched controls. Clinically, CVD in this population manifests as coronary artery disease, arrhythmias, stroke, or congestive heart failure. Beyond the traditional risk factors (eg, diabetes mellitus and hypertension), uremia-specific factors that arise from accumulating toxins also contribute to the pathogenesis of CVD.In this review, we summarize the literature on the epidemiology of both traditional and uremia-related CVD and focus on postulated mechanisms of the latter. P. Jousset, MD, 1 describing common causes of death among patients with Bright disease C hronic kidney disease (CKD) is an increasingly urgent public health concern that is projected to grow worldwide at a rate of 8% annually, with the fastest growth expected in developing nations.2,3 It has long been known that patients with kidney failure are predisposed to cardiovascular disease (CVD) that manifests clinically in various forms, including coronary artery disease, atrial or ventricular arrhythmias, myocardial infarction, stroke, or congestive heart failure. Over the last 30 years, it has become clear that the risk of CVD increases early in the course of progressive kidney disease and that the epidemiology, pathophysiology, prevention, and treatment of CVD and CKD are closely related and interdependent. 4 In this review, we initially describe the epidemiology of CVD among people with CKD, noting the limitations of available research. We then discuss common risk factors for CVD (traditional and nontraditional) and key shared aspects of its pathophysiology with CKD. Next we describe emerging diagnostic tools and novel therapies that may help to delay or prevent end-stage renal disease (ESRD) and to curtail the escalating burden of cardiorenal disease. In the final section, we discuss the health services and health policy challenges that CKD and its inextricably linked CVD morbidities pose worldwide, particularly for low-and middle-income countries (LMICs). Phenotypes and Epidemiology of CVD in Patients With CKDPatients with CKD and some forms of CVD share a number of risk factors and underlying pathophysiological mechanisms that, by virtue of their similarities, offer opportunities to improve their management. The epidemiology of 4 of the commonest clinical phenotypes of CVD associated with CKD is discussed below. Coronary Artery DiseaseCoronary artery disease (CAD) is a leading cause of death among people with advanced CKD. Clinical syndromes compatible with CAD (including angina and myocardial infarction) are exceedingly common in patients with nondialysis-dependent CKD, and the incidence of myocardial

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“…22 Some evidence of regional/ethnic variation exists. For example, the estimated proportion of SCD deaths among Japanese dialysis patients appears lower than in Western dialysis patients.…”

Section: A B D Cmentioning

confidence: 99%

Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

2016

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“…1 In a recent study, about 50% of patients undergoing dialysis had a prolonged QTc interval (> 440 ms). 2 Overall, cardiovascular disease is the primary cause of death in patients with end-stage renal disease, and SCD accounts for 60% of these cases.…”

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confidence: 99%

“…It is most often caused by an interplay of risk factors causing a structural abnormality in the heart and a transient trigger (e.g., medication, electrolyte abnormality) that induces an electrophysiological imbalance. 1 This interaction can predispose individuals to prolongation of the QTc interval, which represents an altered frequency of ventricular repolarization. 2 Ultimately, these electrophysiological changes can lead to fatal ventricular tachyarrhythmia and eventual hemodynamic collapse.…”

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confidence: 99%

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Domperidone-Associated Sudden Cardiac Death in the General Population and Implications for Use in Patients Undergoing Hemodialysis: A Literature Review

Makari

Cameron

Battistella

2014

CJHP

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“…The presence of CKD also associates with various complications and their costs, including cognitive impairment, 14,15 cardiovascular disease, [16][17][18][19] sudden death, 20 abnormal mineral metabolism, [21][22][23] bone fracture, 24 vascular ossification 25 and remodeling, 26 postoperative mortality, 27 risk of AKI, 28,29 cancer, 30 and patient safety 31 just to mention a few. No one is sure all these risks are shared equally across the spectrum of patients with varying degrees of CKD.…”

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confidence: 99%

Web Surveillance for CKD

Neilson

2013

Journal of the American Society of Nephrology

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We all carry a few numbers around regarding the epidemiology of kidney disease. The US Renal Data System (USRDS) remains a treasure chest of robust information about secular trends in ESRD.1 Notably, annual adjusted incidence rates for new cases of ESRD have flattened, whereas absolute incidence counts increase as the base population enlarges.2 Prevalence rates for ESRD are rising, therefore, as a function of increasing incidence counts and the improved longevity of dialysis and transplant patients, all of which suggest that numbers of individuals living with ESRD will grow largely in proportion to size of the population.2 Although escalating expense for renal replacement therapy strains government and private insurance programs, 3 the leveling of adjusted incidence rate challenges the notion that we are facing a relentless epidemic outside of normal population growth and the emergence of younger obese diabetic patients that have not yet run their course of disease.Save for the outcome of AKI, 2 the largest feeder cohort for patients eventually needing renal replacement therapy is the prevalence of CKD in the general population 4 and what we believe about treatment possibilities. 5 The magnitude or validity of this pool currently derives from smaller data sources, particularly the National Health and Nutrition Examination Survey (NHANES), which samples approximately 5,000 persons each year.6,7 CKD also has definition and staging problems 8 among other issues related to creatinine-based equations for renal function, where assays for measuring levels of serum creatinine have changed over time and made it harder to marry one annual trend to another.2 Sadly, the sensitivity of current guidelines staging CKD cannot predict who will progress among patients with early signs of disease. 8 The rate of decline of GFR before onset of CKD differs among races or ethnic groups, but traditional risk factors are not highly predictive of who will show decline. Save for a timely stab at modeling CKD from smaller cohorts, 9 there are no comprehensive datasets readily available for firmer projections of longitudinal progressivity.2 The Hoerger model 9 makes informed assumptions about progression and risk of diabetes and hypertension to predict that 47.1% of 30-year-old people have a lifetime risk of some degree of CKD and estimate that only 11% of patients with stage 3 CKD will ever progress to stage 5. 9 Of course, the estimated period prevalence of CKD in the general population greatly exceeds incidence rates for ESRD, 2,9 reminding us that counting everyone with any level of CKD greatly obscures real risk of renal failure.The burden of comorbidities embedded in the CKD population is also well known and of great interest to health care planners, particularly in regards to diabetes 10,11 and obese 12 and elderly 13 patients, and the contribution cost of comorbidities will vary depending on how new identifiers of progressive CKD are refined from future datasets. No one is sure all these risks are shared equally across the spectrum ...

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CKD and Sudden Cardiac Death

Cited by 118 publications

References 107 publications

Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

Domperidone-Associated Sudden Cardiac Death in the General Population and Implications for Use in Patients Undergoing Hemodialysis: A Literature Review

Web Surveillance for CKD

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