Sudden cardiac death in hemodialysis patients: a comprehensive care approach to reduce risk.

Published

Journal Article (Review)

Sudden cardiac death is a major problem in hemodialysis patients, and our understanding of this disease is underdeveloped. The lack of a precise definition tailored for use in the hemodialysis population limits the reliability of epidemiologic reports. Efforts should be directed toward an accurate classification of all deaths that occur in this vulnerable population. The traditional paradigm of disease pathophysiology based on known cardiac risk factors appears to be inadequate to explain the magnitude of sudden cardiac death risk in chronic kidney disease, and numerous unique cofactors and exposures appear to determine risk in this population. Well-designed cohort studies will be needed for a basic understanding of disease pathophysiology and risk factors, and randomized intervention trials will be needed before best management practices can be implemented. This review examines available data to describe the characteristics of the high-risk patient and suggests a comprehensive common sense approach to prevention using existing cardiovascular medications and reducing and monitoring potential dialysis-related arrhythmic triggers. Other unproven cardiovascular therapies such as implantable cardioverter defibrillators should be used on a case-by-case basis, with recognition of the associated hazards that these devices carry among hemodialysis patients.

Full Text

Duke Authors

Cited Authors

  • Pun, PH; Middleton, JP

Published Date

  • 2012

Published In

Volume / Issue

  • 33 / 1-3

Start / End Page

  • 183 - 189

PubMed ID

  • 22269796

Pubmed Central ID

  • 22269796

Electronic International Standard Serial Number (EISSN)

  • 1421-9735

Digital Object Identifier (DOI)

  • 10.1159/000334154

Language

  • eng

Conference Location

  • Switzerland