Sudden cardiac death in nephrology: focus on acquired long QT syndrome

Gussak, Ihor; Gussak, Hiie M.

doi:10.1093/ndt/gfl587

Cited by 39 publications

(45 citation statements)

References 7 publications

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“…In view of this excessive rate in dialyzed patients, it is quite surprising that a recent task force report on sudden death does not mention dialysis as a predisposing factor, illustrating the need for more interaction between specialties (5). Much of the information on dialysis patients is difficult to interpret: In nonrenal patients, the link between "sudden death" and structural cardiac disease or malfunction of ion channels ("channelopathy") is usually straightforward; in dialysis patients, however, many confounding factors-uncommon in the general population but unrelated to heart disease-may also cause death fulfilling the criteria of sudden death (e.g., hyperkalemia, suicide, air embolism [5,6,14]). The causes of sudden death in dialysis patients may also vary between countries: One autopsy controlled study in Japan found stroke as the most frequent cause of sudden death (25.8%), followed by cardiac disease (19.4%), infectious disease (17.2%), and others (15).…”

Section: Inspector Gregory) "Is There Anything You Wish To Draw My Atmentioning

confidence: 99%

“…An underappreciated aspect of sudden death is the acquired long-QT syndrome (14). It is known that on the one hand the repolarization reserve is diminished by the presumed reduction of K ϩ channels in uremia (14).…”

Section: Qt Dispersion and Qt Prolonging Medication (Acquired Long-qtmentioning

confidence: 99%

“…It is known that on the one hand the repolarization reserve is diminished by the presumed reduction of K ϩ channels in uremia (14). On the other hand, the smaller number of remaining K ϩ channels exhibit increased sensitivity to inhibition (acquired long-QT syndrome).…”

Section: Qt Dispersion and Qt Prolonging Medication (Acquired Long-qtmentioning

confidence: 99%

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The Challenge of Sudden Death in Dialysis Patients

Ritz¹,

Wanner²

2008

Clinical Journal of the American Society of Nephrology

112

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A 60-yr-old patient with ESRD (82 kg/168 cm), hypertension for the previous 18 yr, and type 2 diabetes is found dead in bed by his wife at home on a Saturday morning. The patient's history is notable for having started dialysis 34 weeks previously. His last dialysis had been the previous day (on a Friday afternoon). Predialysis potassium had been 5.7 mmol/L, the dialysate K ϩ was 2.0 mmol/L, and Mg 2ϩ was 0.5 mmol/L. Autopsy was not performed.Before his morbid event, the patient had been doing well on dialysis. He had less than 6 episodes of hypotension (Ͻ100 mmHg) per month. His average predialytic weight gain was 4 kg, and, with fluctuations, his average predialysis BP was 155/65 mmHg. While continuing on gliquidone (an oral sulfonylurea hypoglycemic drug that does not accumulate in renal failure), he had no episodes of hypoglycemia, and his last glycosylated hemoglobin level was 7.2%. His medical history is of hypertension, type 2 diabetes, and left ventricular hypertrophy (LVH) with an ejection fraction of 55%. His electrocardiogram showed signs of LVH and flat T waves. He had no history of hypoglycemic episodes and no evidence of retinopathy. He reported no episodes of arrhythmia or precordial pain. A predialysis chest x-ray 2 wk before the terminal event had shown pulmonary congestion. His medications included 0.25 g/d calcitriol, calcium carbonate, 10 mg of folate, 80 mg of verapamil, and no ␤ blockers. In addition, he received varying doses of darbepoietin and iron gluconate as required. He did not receive a statin. Dr. Eberhard Ritz: This case, unfortunately, is the usual presentation of patients on dialysis who succumb to sudden death: There are few, if any, specific premonitory symptoms or signs, cardiac standstill is usually the presenting symptom, and autopsy is not performed, so more specific information on underlying cardiac pathology, if any, is not available. The lack of pathoanatomic confirmation of the underlying pathology or pathologies-as in this case-continues to remain a problem that in the future should come onto the radar screen of nephrologists.Nevertheless, this case presentation raises a number of unresolved issues and provides an occasion to discuss how the currently unsatisfactory results might be improved in the future. In this context, it is of interest to have a look at the recent 4D study.

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Section: Inspector Gregory) "Is There Anything You Wish To Draw My Atmentioning

confidence: 99%

Section: Qt Dispersion and Qt Prolonging Medication (Acquired Long-qtmentioning

confidence: 99%

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The Challenge of Sudden Death in Dialysis Patients

Ritz¹,

Wanner²

2008

Clinical Journal of the American Society of Nephrology

112

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“…On se izračunava pomoću Bazettove formule: QTc = , gde RR predstavlja dužinu između dve depolarizacije komora u milisekundama. Kod bolesnika na hemodijalizi QTc veći od 500 ms ukazuje na povećan rizik od komorskih poremećaja srčanog ritma (36,37). Standardni EKG pruža mogućnost da se proceni promenljivost trajanja QT intervala (disperzija QTc intervala).…”

Section: Otkrivanje Bolesnika Sa Povećanim Rizikom Od Iznenadne Srčanunclassified

“…Promenljivost korigovanog QTc intervala koristi se za procenu rizika od nastanka komorskih poremećaja srčanog ritma kod bolesnika na hemodijalizi. Promenljivost QTc intervala definiše se kao razlika između najdužeg i najkraćeg QTc intervala registrovanog standardnim elektrokardiogramom (36,37). Normalna promenljivost QTc intervala iznosi 40-50 ms. Kod bolesnika na hemodijalizi, kod kojih je promenljivost QTc intervala veća od 50 ms postoji povećan rizik od nastanka komorskih poremećaja srčanog ritma i iznenadne srčane smrti (36,37).…”

Section: Otkrivanje Bolesnika Sa Povećanim Rizikom Od Iznenadne Srčanunclassified

10.5937/mckg48-4123 = Diastolic heart failure in patients on hemodialysis: Etiopathogenesis, diagnostics and therapy

Nedeljković¹,

Miloradović²,

Radovanović³

et al. 2014

Medicinski casopis

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UVODBolesti srca su vodeći uzrok smrti bolesnika koji se leče redovnim hemodijalizama. Kod ovih bolesnika prisutni su brojni faktori rizika kao što su povišen arterijski krvni pritisak, poremećaj metabolizma lipida, oksidativni stres, mikroinflamacija, hiperhomocisteinemija, anemija, povećan protok krvi kroz vaskularni pristup za hemodijalizu, sekundarni hiperparatireoidizam, a koji su odgovorni za razvoj kardiovaskularnih komplikacija (1). Hipertrofija leve komore, ishemijska bolest srca i srčana slabost su najčešće kardiovaskularne komplikacije kod bolesnika na hemodijalizi (1, 2). PREGLED SAŽETAK

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Analysis of Respiratory Fluoroquinolones and the Risk of Sudden Cardiac Death Among Patients Receiving Hemodialysis

Assimon¹,

Pun

Wang

et al. 2022

JAMA Cardiol

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IMPORTANCE Respiratory fluoroquinolone antibiotics are some of the most common medications with QT interval-prolonging potential prescribed to patients with hemodialysis-dependent kidney failure-individuals who have a very high risk of sudden cardiac death (SCD). To date, there have been no large-scale, population-specific studies evaluating the cardiac safety of respiratory fluoroquinolones in the hemodialysis population.OBJECTIVE To investigate the cardiac safety of respiratory fluoroquinolones among individuals with hemodialysis-dependent kidney failure. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study examining safety using an active comparator new-user design was conducted using administrative claims data from a US-wide kidney failure registry from January 1, 2007, to December 31, 2016, including 264 968 Medicare beneficiaries receiving in-center maintenance hemodialysis. Data analysis was performed from January 4 to August 16, 2021.EXPOSURES Respiratory fluoroquinolone (levofloxacin or moxifloxacin) vs amoxicillin-based (amoxicillin or amoxicillin with clavulanic acid) antibiotic treatment.MAIN OUTCOMES AND MEASURES Sudden cardiac death within 5 days of outpatient initiation of a study antibiotic. Inverse probability of treatment-weighted survival models to estimate hazard ratios (HRs), risk differences (RDs), and corresponding 95% CIs. Death due to a cause other than SCD was treated as a competing event. Fracture was considered as a negative control outcome. RESULTSThe study cohort included 264 968 unique in-center hemodialysis patients and 626 322 study antibiotic treatment episodes: 251 726 respiratory fluoroquinolone treatment episodes (40.2%) and 374 596 amoxicillin-based treatment episodes (59.8%). Of the 264 968 patients, 135 236 (51.0%) were men, and the mean (SD) age was 61 (15) years. Respiratory fluoroquinolone vs amoxicillin-based antibiotic treatment was associated with a higher relative and absolute 5-day risk of SCD (weighted HR, 1.95; 95% CI, 1.57-2.41; and weighted RD per 100 000 treatment episodes, 44.0; 95% CI, 31.0-59.2). Respiratory fluoroquinolone vs amoxicillin-based antibiotic treatment was not associated with the 5-day risk of fracture. CONCLUSIONS AND RELEVANCEIn this study, compared with amoxicillin-based antibiotic treatment, respiratory fluoroquinolone treatment was associated with a higher short-term risk of SCD among patients with hemodialysis-dependent kidney failure. This finding suggests that decisions between the use of respiratory fluoroquinolones and amoxicillin-based antibiotics should be individualized, with prescribers considering both the clinical benefits and potential cardiac risks.

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Sudden cardiac death in nephrology: focus on acquired long QT syndrome

Cited by 39 publications

References 7 publications

The Challenge of Sudden Death in Dialysis Patients

The Challenge of Sudden Death in Dialysis Patients

10.5937/mckg48-4123 = Diastolic heart failure in patients on hemodialysis: Etiopathogenesis, diagnostics and therapy

Analysis of Respiratory Fluoroquinolones and the Risk of Sudden Cardiac Death Among Patients Receiving Hemodialysis

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