Moderate Kidney Dysfunction Independently Increases Sudden Cardiac Arrest Risk: A Community‐Based Study

Abstract

Background Moderate kidney dysfunction is independently associated with increased cardiovascular death. Sudden cardiac arrest (SCA) accounts for at least 25% of chronic kidney disease (CKD) death. This study aimed to evaluate the impact of moderate CKD on SCA risk. Methods We conducted a case–control study within a community‐based investigation of SCA in the Portland, Oregon, metropolitan area from February 1, 2002, to December 31, 2020. Analysis included individuals aged 40 to 75 years who experienced SCA (cases) and individuals with no history of SCA (controls), with creatinine levels measured before SCA/enrollment. Moderate CKD was defined by an estimated glomerular filtration rate of 30 to <60 mL/min per 1.73 m 2 (2021 Chronic Kidney Disease Epidemiology Collaboration formula). A population‐based SCA study in southern California was used for validation. Results We compared 2068 SCA cases and 852 controls (mean ages, 61.4±8.5 and 62.7±8.0 years, respectively; men: 69.9% and 67.4%, respectively). SCA cases had more moderate CKD (17.7% versus 14.7%, P <0.001) and lower estimated glomerular filtration rate (74.7 versus 80.9 mL/min per 1.73 m 2 , P <0.001) than controls. Multivariable regression demonstrated that moderate CKD was an independent risk factor for SCA (odds ratio, 1.32 [95% CI, 1.02–1.71]). Each 10 mL/min per 1.73 m 2 estimated glomerular filtration rate drop to <90 increased SCA risk (odds ratio, 1.24 [95% CI, 1.18–1.31]). Similar findings were observed in the validation cohort (817 SCA and 3249 controls), where moderate CKD was associated with SCA (odds ratio, 1.54 [95% CI, 1.18–2.00]). Conclusions Moderate CKD is associated with an increased risk of SCA in the general population. Further research into the potential integration of moderate renal dysfunction into SCA risk stratification are warranted.

Mortality Trends Involving Cardiac Arrest and Fluid, Electrolyte, and Acid–Base Disorders in U.S. Adults, 2004–2024

“…The increasing prevalence of chronic conditions, such as complicated diabetes and hypertension, hyperlipidemia, and obesity over the years, may have further exacerbated the rise in metabolic and electrolyte disturbances, as diabetes is commonly linked with hyponatremia, hyperkaliemia, hypomagnesemia, hypocalcemia, and anion-gap and hyperchloremic normal-gap acidosis seen frequently in diabetic ketoacidosis [20,21]. Chronic kidney disease is another condition commonly associated with electrolyte and acid-base abnormalities especially in sudden cardiac death cases, and may partially explain the increasing co-occurrence of these metabolic imbalances in mortality records [22]. Furthermore, according to the Cardiac Arrest Registry to Enhance Survival, 21.6% of patients with OHCA are found dead before reaching a medical facility, and many, unfortunately, do not receive bystander-aided cardiopulmonary resuscitation (CPR) and other necessary interventions known to increase survival benefit, highlighting significant gaps in prehospital OHCA care and its contributions to an overall higher CA mortality [23].…”

Mortality Trends Involving Cardiac Arrest and Fluid, Electrolyte, and Acid–Base Disorders in U.S. Adults, 2004–2024

“…The increasing prevalence of chronic conditions, such as complicated diabetes and hypertension, hyperlipidemia, and obesity over the years, may have further exacerbated the rise in metabolic and electrolyte disturbances, as diabetes is commonly linked with hyponatremia, hyperkaliemia, hypomagnesemia, hypocalcemia, and anion-gap and hyperchloremic normal-gap acidosis seen frequently in diabetic ketoacidosis [20,21]. Chronic kidney disease is another condition commonly associated with electrolyte and acid-base abnormalities especially in sudden cardiac death cases, and may partially explain the increasing co-occurrence of these metabolic imbalances in mortality records [22]. Furthermore, according to the Cardiac Arrest Registry to Enhance Survival, 21.6% of patients with OHCA are found dead before reaching a medical facility, and many, unfortunately, do not receive bystander-aided cardiopulmonary resuscitation (CPR) and other necessary interventions known to increase survival benefit, highlighting significant gaps in prehospital OHCA care and its contributions to an overall higher CA mortality [23].…”

Beyond cardiac risk factors: non-cardiovascular comorbidities in sudden cardiac death prediction

“…In ORSUDS, which included 2,068 SCA cases and 852 controls without history of ventricular arrhythmia or SCA, moderate CKD (stages 3a and 3b) emerged as an independent risk factor for SCA (OR 1.3, 95% CI 1.0–1.7). Notably, SCA risk increased by 24% for every 10 ml/min per 1.73 m 2 decrease in eGFR below 90 ml/min per 1.73 m 2 ( 51 ). These findings were validated in the PRESTO study including 817 SCA cases and 3,249 controls, which confirmed that moderate CKD was independently associated with SCA (OR 1.5, 95% CI 1.2–2.0), with a 41% increased risk for every 10 ml/min per 1.73 m 2 decrease in eGFR below 90 ml/min per 1.73 m 2 .…”

“…Hepatic pathology demonstrates comparable patterns: cirrhotic patients present with non-shockable rhythms in 75% of cases vs. 42% without cirrhosis ( p < 0.001) ( 87 , 88 ). CKD associates with predominantly non-shockable presentations across multiple community studies ( 51 , 89 ). Particularly, Implantable loop recorder data from hemodialysis patients reveal bradycardia and asystole—rather than ventricular arrhythmias—as the dominant terminal rhythms ( 90 ).…”

A Clinical Prediction Model for Sudden Cardiac Arrest Presenting as Pulseless Electrical Activity

“…To construct the risk score model, we considered patient demographics (age, sex, and race/ethnicity), and the following clinical predictors (n=16) and medications (n=3) based on prior association with SCA: body mass index (BMI, calculated as weight [kg]/height [m]2), diabetes mellitus (DM), hypertension, heart failure (HF), stroke, atrial fibrillation, history of myocardial infarction (MI), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), seizure disorder, history of syncope, anemia, sleep apnea, peripheral vascular disease (PVD), mood disorder, cancer, and medications (anti-psychotic, anti-depressants and beta blockers) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] .…”

Mortality Trends Involving Cardiac Arrest and Fluid, Electrolyte, and Acid–Base Disorders in U.S. Adults, 2004–2024

“…The increasing prevalence of chronic conditions, such as complicated diabetes and hypertension, hyperlipidemia, and obesity over the years, may have further exacerbated the rise in metabolic and electrolyte disturbances, as diabetes is commonly linked with hyponatremia, hyperkaliemia, hypomagnesemia, hypocalcemia, and anion-gap and hyperchloremic normal-gap acidosis seen frequently in diabetic ketoacidosis [20,21]. Chronic kidney disease is another condition commonly associated with electrolyte and acid-base abnormalities especially in sudden cardiac death cases, and may partially explain the increasing co-occurrence of these metabolic imbalances in mortality records [22]. Furthermore, according to the Cardiac Arrest Registry to Enhance Survival, 21.6% of patients with OHCA are found dead before reaching a medical facility, and many, unfortunately, do not receive bystander-aided cardiopulmonary resuscitation (CPR) and other necessary interventions known to increase survival benefit, highlighting significant gaps in prehospital OHCA care and its contributions to an overall higher CA mortality [23].…”

Beyond cardiac risk factors: non-cardiovascular comorbidities in sudden cardiac death prediction

“…In ORSUDS, which included 2,068 SCA cases and 852 controls without history of ventricular arrhythmia or SCA, moderate CKD (stages 3a and 3b) emerged as an independent risk factor for SCA (OR 1.3, 95% CI 1.0–1.7). Notably, SCA risk increased by 24% for every 10 ml/min per 1.73 m 2 decrease in eGFR below 90 ml/min per 1.73 m 2 ( 51 ). These findings were validated in the PRESTO study including 817 SCA cases and 3,249 controls, which confirmed that moderate CKD was independently associated with SCA (OR 1.5, 95% CI 1.2–2.0), with a 41% increased risk for every 10 ml/min per 1.73 m 2 decrease in eGFR below 90 ml/min per 1.73 m 2 .…”

“…Hepatic pathology demonstrates comparable patterns: cirrhotic patients present with non-shockable rhythms in 75% of cases vs. 42% without cirrhosis ( p < 0.001) ( 87 , 88 ). CKD associates with predominantly non-shockable presentations across multiple community studies ( 51 , 89 ). Particularly, Implantable loop recorder data from hemodialysis patients reveal bradycardia and asystole—rather than ventricular arrhythmias—as the dominant terminal rhythms ( 90 ).…”

A Clinical Prediction Model for Sudden Cardiac Arrest Presenting as Pulseless Electrical Activity

“…To construct the risk score model, we considered patient demographics (age, sex, and race/ethnicity), and the following clinical predictors (n=16) and medications (n=3) based on prior association with SCA: body mass index (BMI, calculated as weight [kg]/height [m]2), diabetes mellitus (DM), hypertension, heart failure (HF), stroke, atrial fibrillation, history of myocardial infarction (MI), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), seizure disorder, history of syncope, anemia, sleep apnea, peripheral vascular disease (PVD), mood disorder, cancer, and medications (anti-psychotic, anti-depressants and beta blockers) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] .…”

Mortality Trends Involving Cardiac Arrest and Fluid, Electrolyte, and Acid–Base Disorders in U.S. Adults, 2004–2024

“…The increasing prevalence of chronic conditions, such as complicated diabetes and hypertension, hyperlipidemia, and obesity over the years, may have further exacerbated the rise in metabolic and electrolyte disturbances, as diabetes is commonly linked with hyponatremia, hyperkaliemia, hypomagnesemia, hypocalcemia, and anion-gap and hyperchloremic normal-gap acidosis seen frequently in diabetic ketoacidosis [20,21]. Chronic kidney disease is another condition commonly associated with electrolyte and acid-base abnormalities especially in sudden cardiac death cases, and may partially explain the increasing co-occurrence of these metabolic imbalances in mortality records [22]. Furthermore, according to the Cardiac Arrest Registry to Enhance Survival, 21.6% of patients with OHCA are found dead before reaching a medical facility, and many, unfortunately, do not receive bystander-aided cardiopulmonary resuscitation (CPR) and other necessary interventions known to increase survival benefit, highlighting significant gaps in prehospital OHCA care and its contributions to an overall higher CA mortality [23].…”

Beyond cardiac risk factors: non-cardiovascular comorbidities in sudden cardiac death prediction

“…In ORSUDS, which included 2,068 SCA cases and 852 controls without history of ventricular arrhythmia or SCA, moderate CKD (stages 3a and 3b) emerged as an independent risk factor for SCA (OR 1.3, 95% CI 1.0–1.7). Notably, SCA risk increased by 24% for every 10 ml/min per 1.73 m 2 decrease in eGFR below 90 ml/min per 1.73 m 2 ( 51 ). These findings were validated in the PRESTO study including 817 SCA cases and 3,249 controls, which confirmed that moderate CKD was independently associated with SCA (OR 1.5, 95% CI 1.2–2.0), with a 41% increased risk for every 10 ml/min per 1.73 m 2 decrease in eGFR below 90 ml/min per 1.73 m 2 .…”

“…Hepatic pathology demonstrates comparable patterns: cirrhotic patients present with non-shockable rhythms in 75% of cases vs. 42% without cirrhosis ( p < 0.001) ( 87 , 88 ). CKD associates with predominantly non-shockable presentations across multiple community studies ( 51 , 89 ). Particularly, Implantable loop recorder data from hemodialysis patients reveal bradycardia and asystole—rather than ventricular arrhythmias—as the dominant terminal rhythms ( 90 ).…”

A Clinical Prediction Model for Sudden Cardiac Arrest Presenting as Pulseless Electrical Activity

“…To construct the risk score model, we considered patient demographics (age, sex, and race/ethnicity), and the following clinical predictors (n=16) and medications (n=3) based on prior association with SCA: body mass index (BMI, calculated as weight [kg]/height [m]2), diabetes mellitus (DM), hypertension, heart failure (HF), stroke, atrial fibrillation, history of myocardial infarction (MI), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), seizure disorder, history of syncope, anemia, sleep apnea, peripheral vascular disease (PVD), mood disorder, cancer, and medications (anti-psychotic, anti-depressants and beta blockers) [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] .…”