Sudden Cardiac Death Among Hemodialysis Patients.

Journal Article (Review;Journal Article)

Hemodialysis patients carry a large burden of cardiovascular disease; most onerous is the high risk for sudden cardiac death. Defining sudden cardiac death among hemodialysis patients and understanding its pathogenesis are challenging, but inferences from the existing literature reveal differences between sudden cardiac death among hemodialysis patients and the general population. Vascular calcifications and left ventricular hypertrophy may play a role in the pathophysiology of sudden cardiac death, whereas traditional cardiovascular risk factors seem to have a more muted effect. Arrhythmic triggers also differ in this group as compared to the general population, with some arising uniquely from the hemodialysis procedure. Combined, these factors may alter the types of terminal arrhythmias that lead to sudden cardiac death among hemodialysis patients, having important implications for prevention strategies. This review highlights current knowledge on the epidemiology, pathophysiology, and risk factors for sudden cardiac death among hemodialysis patients. We then examine strategies for prevention, including the use of specific cardiac medications and device-based therapies such as implantable defibrillators. We also discuss dialysis-specific prevention strategies, including minimizing exposure to low potassium and calcium dialysate concentrations, extending dialysis treatment times or adding sessions to avoid rapid ultrafiltration, and lowering dialysate temperature.

Full Text

Duke Authors

Cited Authors

  • Makar, MS; Pun, PH

Published Date

  • May 2017

Published In

Volume / Issue

  • 69 / 5

Start / End Page

  • 684 - 695

PubMed ID

  • 28223004

Pubmed Central ID

  • PMC5457912

Electronic International Standard Serial Number (EISSN)

  • 1523-6838

International Standard Serial Number (ISSN)

  • 0272-6386

Digital Object Identifier (DOI)

  • 10.1053/j.ajkd.2016.12.006


  • eng