Scholars@Duke
Patrick Hank Pun

Patrick Hank Pun

Associate Professor of Medicine
Medicine, Nephrology
Duke Box 17969, Durham, NC 27705
PO Box 17969, 2400 Pratt St Rm 0311 Terrace Level, Durham, NC 27705

Selected Publications

Public access defibrillator locations and details in Forsyth County, North Carolina: Results of a telephone survey canvas of large businesses to facilitate out-of-hospital cardiac arrest treatment.

Journal Article Am J Emerg Med · November 2024 BACKGROUND: Limited data are available on locations of public access defibrillation programs across communities in the United States, despite their widespread presence. Our goal was to determine publicly available AED locations of large businesses in a mix ... Full text Link to item Cite

Prescription and Dispensation of QT-Prolonging Medications in Individuals Receiving Hemodialysis.

Journal Article JAMA Netw Open · April 1, 2024 IMPORTANCE: Individuals with dialysis-dependent kidney failure have numerous risk factors for medication-related adverse events, including receipt of care by multiple clinicians and initiation of some QT-prolonging medications with known risk of torsades d ... Full text Link to item Cite

Point-of-Care Chemistry-Guided Dialysate Adjustment to Reduce Arrhythmias: A Pilot Trial.

Journal Article Kidney Int Rep · November 2023 INTRODUCTION: Excessive dialytic potassium (K) and acid removal are risk factors for arrhythmias; however, treatment-to-treatment dialysate modification is rarely performed. We conducted a multicenter, pilot randomized study to test the safety, feasibility ... Full text Link to item Cite

Association of Acute Kidney Injury and Cardiovascular Disease Following Percutaneous Coronary Intervention: Assessment of Interactions by Race, Diabetes, and Kidney Function.

Journal Article Am J Kidney Dis · June 2023 RATIONALE & OBJECTIVE: Black patients and those with diabetes or reduced kidney function experience a disproportionate burden of acute kidney injury (AKI) and cardiovascular events. However, whether these factors modify the association between AKI and card ... Full text Link to item Cite

QT-Prolonging Antibiotics, Serum-to-Dialysate Potassium Gradient, and Risk of Sudden Cardiac Death Among Patients Receiving Maintenance Hemodialysis.

Journal Article Kidney Med · May 2023 RATIONALE & OBJECTIVE: Treatment with certain QT interval-prolonging antibiotics is associated with a higher risk of sudden cardiac death among individuals with hemodialysis-dependent kidney failure. Concurrent exposure to large serum-to-dialysate potassiu ... Full text Link to item Cite

letter to the editor.

Journal Article Kidney Int · November 2022 Full text Link to item Cite

The modifying effect of the serum-to-dialysate potassium gradient on the cardiovascular safety of SSRIs in the hemodialysis population: a pharmacoepidemiologic study.

Journal Article Nephrol Dial Transplant · October 19, 2022 BACKGROUND: Hypokalemia is a risk factor for drug-induced QT prolongation. Larger serum-to-dialysate potassium gradients during hemodialysis (HD) may augment the proarrhythmic risks of selective serotonin reuptake inhibitors (SSRIs). METHODS: We conducted ... Full text Link to item Cite

Azithromycin use increases the risk of sudden cardiac death in patients with hemodialysis-dependent kidney failure.

Journal Article Kidney Int · October 2022 Azithromycin is an antibiotic with QT-prolonging potential commonly prescribed to individuals receiving hemodialysis. Hemodialysis patients have a high prevalence of clinical conditions, such as structural heart disease, that can enhance the pro-arrhythmic ... Full text Link to item Cite

Facility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics.

Journal Article Kidney360 · June 30, 2022 BACKGROUND: Cardiac arrest occurs frequently in outpatient dialysis clinics, and immediate cardiopulmonary resuscitation (CPR) provision improves patient outcomes. However, Black patients in dialysis clinics receive CPR from clinic staff less often compare ... Full text Link to item Cite

Proton pump inhibitors may enhance the risk of citalopram- and escitalopram-associated sudden cardiac death among patients receiving hemodialysis.

Journal Article Pharmacoepidemiol Drug Saf · June 2022 PURPOSE: Polypharmacy is common in the hemodialysis population and increases the likelihood that patients will be exposed to clinically significant drug-drug interactions. Concurrent use of proton pump inhibitors (PPIs) with citalopram or escitalopram may ... Full text Link to item Cite

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

Journal Article JAMA Cardiol · January 1, 2022 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 deat ... Full text Link to item Cite

Racial Disparities in Invasive Management for Patients With Acute Myocardial Infarction With Chronic Kidney Disease.

Journal Article Circ Cardiovasc Interv · January 2022 BACKGROUND: Due to increased risks of contrast nephropathy, chronic kidney disease (CKD) can deter consideration of invasive management for patients with myocardial infarction (MI). Black patients have a higher prevalence of CKD. Whether racial disparities ... Full text Link to item Cite

Estimated Glomerular Filtration Rate Variability in Patients With Heart Failure and Chronic Kidney Disease.

Journal Article J Card Fail · November 2021 BACKGROUND: Greater variability in the estimated glomerular filtration rate (eGFR) is associated with higher mortality in patients with chronic kidney disease (CKD). Heart failure (HF) is common in CKD and may increase variability through changes in hemody ... Full text Link to item Cite

Racial Differences in AKI Incidence Following Percutaneous Coronary Intervention.

Journal Article J Am Soc Nephrol · March 2021 BACKGROUND: Undergoing percutaneous coronary intervention (PCI) is a risk factor for AKI development, but few studies have quantified racial differences in AKI incidence after this procedure. METHODS: We examined the association of self-reported race (Blac ... Full text Link to item Cite

Trends in Use and In-Hospital Outcomes of Subcutaneous Implantable Cardioverter Defibrillators in Patients Undergoing Long-Term Dialysis.

Journal Article Clin J Am Soc Nephrol · November 6, 2020 BACKGROUND AND OBJECTIVES: Patients on dialysis are at high risk of complications related to implantable cardioverter defibrillator (ICD) implantation; use of subcutaneous ICDs may be preferred over transvenous devices due to lower risk of bloodstream infe ... Full text Link to item Cite

Association between patient race and staff resuscitation efforts after cardiac arrest in outpatient dialysis clinics: A study from the CARES surveillance group.

Journal Article Resuscitation · November 2020 BACKGROUND: Cardiac arrest is the leading cause of death among patients receiving hemodialysis. Despite guidelines recommending CPR training and AED presence in dialysis clinics, rates of CPR and AED use by dialysis staff are suboptimal. Given that racial ... Full text Open Access Link to item Cite

Use of QT Prolonging Medications by Hemodialysis Patients and Individuals Without End-Stage Kidney Disease.

Journal Article J Am Heart Assoc · July 7, 2020 Background The rate of sudden cardiac death in the hemodialysis population exceeds that of the general population by >20-fold. Hemodialysis patients may be particularly susceptible to sudden cardiac death provoked by drug-induced QT prolongation because of ... Full text Link to item Cite

In-Hospital Cardiac Arrest Resuscitation Practices and Outcomes in Maintenance Dialysis Patients.

Journal Article Clin J Am Soc Nephrol · February 7, 2020 BACKGROUND AND OBJECTIVES: Patients on maintenance dialysis with in-hospital cardiac arrest have been reported to have worse outcomes relative to those not on dialysis; however, it is unknown if poor outcomes are related to the quality of resuscitation. Us ... Full text Link to item Cite

Barriers and Facilitators to Performing Cardiopulmonary Resuscitation During Treatment in Outpatient Hemodialysis Clinics: A Qualitative Study.

Journal Article Nephrol Nurs J · 2020 Cardiac arrest is the leading cause of death among patients receiving hemodialysis, and major deficiencies exist in hemodialysis staff-provided cardiopulmonary resuscitation (CPR). Our study aimed to identify factors influencing CPR delivery in the outpati ... Link to item Cite

Authors' Reply.

Journal Article J Am Soc Nephrol · June 2019 Full text Link to item Cite

Outcomes for Hemodialysis Patients Given Cardiopulmonary Resuscitation for Cardiac Arrest at Outpatient Dialysis Clinics.

Journal Article J Am Soc Nephrol · March 2019 BACKGROUND: Out-of-hospital cardiac arrest, the leading cause of death among patients on hemodialysis, occurs frequently within outpatient dialysis centers. Practice guidelines recommend resuscitation training for all dialysis clinic staff and on-site defi ... Full text Link to item Cite

CHRONIC KIDNEY DISEASE AND ARRHYTHMIAS: CONCLUSIONS FROM A KIDNEY DISEASE: IMPROVING GLOBAL OUTCOMES (KDIGO) CONTROVERSIES CONFERENCE

Journal Article Nephrology (Saint-Petersburg) · January 1, 2019 Patients with chronic kidney disease (CKD) are predisposed to heart rhythm disorders, including atrial fibrillation (AF)/atrial flutter, supraventricular tachycardias, ventricular arrhythmias, and sudden cardiac death (SCD). While treatment options, includ ... Full text Cite

The Association of Kidney Function and Albuminuria With the Risk and Outcomes of Syncope: A Population-Based Cohort Study.

Journal Article Can J Cardiol · December 2018 BACKGROUND: The risks and subsequent outcomes of syncope among seniors with chronic kidney disease (CKD) are unclear. METHODS: We conducted a population-based retrospective cohort study of 272,146 patients ≥ 66 years old, in Ontario, Canada, from April 1, ... Full text Link to item Cite

Dialysate potassium concentration: Should mass balance trump electrophysiology?

Journal Article Semin Dial · November 2018 Nephrologists are faced with a difficult dilemma in choosing the ideal dialysis prescription to maintain neutral potassium mass balance. Should potassium mass balance goals prioritize the normalization of serum potassium levels using low potassium dialysat ... Full text Link to item Cite

Dialysate Potassium, Dialysate Magnesium, and Hemodialysis Risk.

Journal Article Journal of the American Society of Nephrology : JASN · December 2017 One of the fundamental goals of the hemodialysis prescription is to maintain serum potassium levels within a narrow normal range during both the intradialytic and interdialytic intervals. Considering the extraordinarily high rate of cardiovascular mortalit ... Full text Cite

Serum Potassium Levels and Risk of Sudden Cardiac Death Among Patients With Chronic Kidney Disease and Significant Coronary Artery Disease.

Journal Article Kidney Int Rep · November 2017 INTRODUCTION: Chronic kidney disease (CKD) patients have increased risks of sudden cardiac arrest and sudden cardiac death (SCA/SCD) that are not explained by traditional risk factors. We examined associations between serum potassium and SCA/SCD in a large ... Full text Link to item Cite

Do Implantable Cardioverter-Defibrillators Lower the Risk of Sudden Death and Total Mortality in Patients with End-Stage Renal Disease?

Journal Article Current Cardiovascular Risk Reports · September 1, 2017 Purpose of Review: Although the risk of sudden cardiac death is high in patients with end-stage renal disease (ESRD), it is not clear if such patients benefit from the implantable cardioverter defibrillator (ICD). This paper reviews data on the risk of sud ... Full text Cite

Sudden Cardiac Death Among Hemodialysis Patients.

Journal Article Am J Kidney Dis · May 2017 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 ... Full text Link to item Cite

Prescription of Guideline-Recommended Implantable Cardioverter Defibrillator and Cardiac Resynchronization Therapy Among Patients Hospitalized With Heart Failure and Varying Degrees of Renal Function.

Journal Article Am J Cardiol · March 15, 2017 Implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) reduce mortality in many patients with heart failure (HF), but the current use and effectiveness of ICD/CRT in patients with chronic kidney disease (CKD) are uncertai ... Full text Link to item Cite

Apolipoprotein L1 Genetic Variants Are Associated with Chronic Kidney Disease but Not with Cardiovascular Disease in a Population Referred for Cardiac Catheterization.

Journal Article Cardiorenal Med · February 2017 BACKGROUND: While the association between APOL1 genetic variants and chronic kidney disease (CKD) has been established, their association with cardiovascular disease (CVD) is unclear. This study sought to understand CKD and cardiovascular risk conferred by ... Full text Link to item Cite

Cinacalcet, dialysate calcium concentration, and cardiovascular events in the EVOLVE trial.

Journal Article Hemodial Int · July 2016 Among patients receiving hemodialysis, abnormalities in calcium regulation have been linked to an increased risk of cardiovascular events. Cinacalcet lowers serum calcium concentrations through its effect on parathyroid hormone secretion and has been hypot ... Full text Link to item Cite

Primary prevention implantable cardioverter defibrillators in end-stage kidney disease patients on dialysis: a matched cohort study.

Journal Article Nephrol Dial Transplant · May 2015 BACKGROUND: Sudden cardiac death is the leading cause of death among end-stage kidney disease patients (ESKD) on dialysis, but the benefit of primary prevention implantable cardioverter defibrillators (ICDs) in this population is uncertain. We conducted th ... Full text Link to item Cite

The interplay between CKD, sudden cardiac death, and ventricular arrhythmias.

Journal Article Adv Chronic Kidney Dis · November 2014 CKD patients face an increased risk of cardiovascular disease mortality, and the risk of sudden cardiac death (SCD) increases as kidney function declines. Risk factors for SCD are poorly understood and understudied among CKD patients. In the general popula ... Full text Link to item Cite

Survival after primary prevention implantable cardioverter-defibrillator placement among patients with chronic kidney disease.

Journal Article Circ Arrhythm Electrophysiol · October 2014 BACKGROUND: Guidelines recommend that implantable cardioverter-defibrillator (ICD) candidates have an estimated longevity of ≥1 year. Longevity can be affected by chronic kidney disease (CKD). METHODS AND RESULTS: Using the National Cardiovascular Data Reg ... Full text Link to item Cite

Implantable cardioverter-defibrillators for primary prevention of sudden cardiac death in CKD: a meta-analysis of patient-level data from 3 randomized trials.

Journal Article Am J Kidney Dis · July 2014 BACKGROUND: The benefit of a primary prevention implantable cardioverter-defibrillator (ICD) among patients with chronic kidney disease is uncertain. STUDY DESIGN: Meta-analysis of patient-level data from randomized controlled trials. SETTING & POPULATION: ... Full text Link to item Cite

Sudden cardiac arrest in ESRD patients.

Journal Article Clin Nephrol · February 2014 End-stage renal disease (ESRD) carries a significant risk for sudden cardiac arrest (SCA), hospitalization and mortality. We present a case of a vintage hemodialysis patient who had a catastrophic event during his hemodialysis treatment - a sudden cardiac ... Full text Link to item Cite

Impact of Kidney Function on Effects of the Dietary Approaches to Stop Hypertension (Dash) Diet.

Journal Article J Hypertens (Los Angel) · 2014 OBJECTIVES: Although the Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure in adults with hypertension, how kidney function impacts this effect is not known. We evaluated whether Estimated Glomerular Filtration Rate (eGFR) modifies ... Full text Open Access Link to item Cite

Dialysate calcium concentration and the risk of sudden cardiac arrest in hemodialysis patients.

Journal Article Clin J Am Soc Nephrol · May 2013 BACKGROUND AND OBJECTIVES: The optimal dialysate calcium concentration to maintain normal mineralization and reduce risk of cardiovascular events in hemodialysis patients is debated. Guidelines suggest that dialysate Ca concentration should be lowered to a ... Full text Link to item Cite

Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis.

Journal Article N Engl J Med · December 27, 2012 BACKGROUND: Disorders of mineral metabolism, including secondary hyperparathyroidism, are thought to contribute to extraskeletal (including vascular) calcification among patients with chronic kidney disease. It has been hypothesized that treatment with the ... Full text Link to item Cite

Improving ascertainment of sudden cardiac death in patients with end stage renal disease.

Journal Article Clin J Am Soc Nephrol · January 2012 BACKGROUND AND OBJECTIVES: Data collected by the US Renal Data System (USRDS) identify sudden cardiac death (SCD) as the leading cause of death among hemodialysis patients. However, evidence suggests that clinical events captured on the USRDS death notific ... Full text Link to item Cite

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

Journal Article Blood Purif · 2012 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. Eff ... Full text Link to item Cite

Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO).

Journal Article Kidney Int · September 2011 Cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) is high, and the presence of CKD worsens outcomes of cardiovascular disease (CVD). CKD is associated with specific risk factors. Emerging evidence indicates that the patho ... Full text Link to item Cite

Secondary hyperparathyroidism

Chapter · January 1, 2011 Full text Cite

Modifiable risk factors associated with sudden cardiac arrest within hemodialysis clinics.

Journal Article Kidney Int · January 2011 Sudden cardiac arrest is the most common cause of death among patients with end-stage kidney disease (ESKD) maintained on hemodialysis. Here we sought to identify dialysis-related factors associated with this increased risk in a case-control study encompas ... Full text Link to item Cite

The authors reply:

Journal Article Kidney International · January 1, 2011 Full text Cite

Hypertension, chronic kidney disease, and the development of cardiovascular risk: a joint primacy.

Journal Article Kidney Int · May 2010 Featured Publication Patients with chronic kidney disease (CKD) have an inordinate risk of cardiovascular disease. In addition to the metabolic state of uremia, the CKD-associated risk is partly explainable by unique cofactors such as dyslipidemia, systemic inflammation, and e ... Full text Link to item Cite

CHRONIC KIDNEY DISEASE, RISK OF CARDIAC ARREST, AND MYOCARDIAL FIBROSIS

Conference JOURNAL OF INVESTIGATIVE MEDICINE · February 1, 2010 Link to item Cite

The authors reply

Journal Article Kidney International · January 1, 2010 Full text Cite

Chronic kidney disease is associated with increased risk of sudden cardiac death among patients with coronary artery disease.

Journal Article Kidney Int · September 2009 Featured Publication Sudden cardiac death is the most common cause of mortality among patients with end-stage kidney disease maintained on hemodialysis. To examine whether this increased risk is also seen with less advanced kidney disease, we studied the relationship between g ... Full text Link to item Cite

Methods of hemodialysis anticoagulation

Journal Article · December 1, 2008 Full text Cite

Predictors of survival after cardiac arrest in outpatient hemodialysis clinics.

Journal Article Clin J Am Soc Nephrol · May 2007 Featured Publication Cardiac arrest (CA) is the most common cause of death in hemodialysis patients, and factors that improve survival after arrest are unknown. This study sought to identify modifiable factors that are associated with survival after CA in hemodialysis clinics. ... Full text Link to item Cite

Automated external defibrillators and survival from cardiac arrest in the outpatient hemodialysis clinic.

Journal Article J Am Soc Nephrol · January 2007 Featured Publication Automated external defibrillators (AED) have been recommended for use in outpatient dialysis clinics to improve outcomes from cardiac arrest, the most common cause of death in patients with ESRD. The effectiveness of this policy is unknown. The study cohor ... Full text Link to item Cite