The Incidence and Associated Factors of Sudden Death in Patients on Hemodialysis: 10-Year Outcome of the Q-Cohort Study

Abstract

The incidence of sudden death and its risk factors in patients on hemodialysis remain unclear. This study aimed to clarify the incidence of sudden death and its risk factors in Japanese patients on hemodialysis. Methods: A total of 3505 patients on hemodialysis aged ≥ 18 years were followed for 10 years. Multivariateadjusted hazard ratio (HR) with 95% confidence interval (95% CI) of each risk factor of sudden death were calculated using a Cox proportional hazards model. Results: During the 10-year follow-up, 1735 patients died, including 227 (13%) sudden deaths. The incidence rate of sudden death was 9.13 per 1000 person-years. In multivariable-adjusted Cox analysis, male sex (HR 1.67; 95% CI 1.20-2.33), age (HR 1.44; 95% CI 1.26-1.65 per 10-year higher), the presence of diabetes (HR 2.45; 95% CI 1.82-3.29), history of cardiovascular disease (HR 1.85; 95% CI 1.38-2.46), cardiothoracic ratio (HR 1.21; 95% CI 1.07-1.39 per 5% higher), serum C-reactive protein (HR 1.11; 95% CI 1.03-1.20 per 1-mg/dL higher), and serum phosphate (HR 1.15; 95% CI 1.03-1.30 per 1-mg/dL higher) were independent predictors of sudden death. A subgroup analysis stratified by sex or age showed that lower serum corrected calcium levels, not using vitamin D receptor activators in women, and a shorter dialysis session length in men or older people (≥ 65 years) increased the risk for sudden death. Conclusions: This study clarified the incidence of sudden death and its specific predictors in Japanese patients on hemodialysis.

Low Free Triiodothyronine Level as a Predictor of Cardiovascular Events and All-Cause Mortality in Patients Undergoing Hemodialysis: The DREAM Cohort

“…Due to the limited number of outcomes of this relatively small cohort, organ-specific and etiology-specific interpretations of the results were difficult. Sixth, although some cohort studies reported a long-term follow-up for 10 years in hemodialysis patients 33) , our cohort was followed up for only 5 years. A longer follow-up period merits a larger number of outcomes, whereas it would analyze the association of the exposure with remote outcomes.…”

Near-sudden unexpected death in a patient with epilepsy undergoing hemodialysis: a case report

“…In HD patients, SD could be induced by various factors such as the presence or history of cardiovascular disease, the problem of fluid volume, electrolyte disorder, and sympathetic overactivity [ 23 ]. Thus, the onset of SD is determined to be most common in the first year or approximately 10 years after HD initiation [ 3 , 24 ]. The increased SD rate would be due to the increased volume and potassium accumulated over a longer weekend interval [ 25 ].…”

“…Sudden death (SD) is considered a common occurrence in patients undergoing hemodialysis (HD) [ 1 ]. Recent studies show that 13–16% of all deaths in Japanese HD patients were due to SD [ 2 , 3 ]; this indicates that SD is now more common even in the Japanese dialysis clinical setting than previously believed [ 4 ]. HD patients are determined to be at an increased risk for SD due to several reasons.…”

Is Stiffness Parameter β Useful for the Evaluation of Atherosclerosis?~ Its Clinical Implications, Limitations, and Future Perspectives ~

“…Patients with chronic kidney disease (CKD) and/ or those on dialysis therapy have multiple risk factors for CVD 74,75) ; thus, it is critical to predict and prevent CVD by making use of surrogate markers 76,77) . There are several reports regarding stiffness parameter in patients with CKD and/or those undergoing hemodialysis.…”