Aldosterone and Cortisol affect the risk of sudden cardiac death in hemodialysis patients

Sudden cardiac death is common and accounts to a large extent for the excess mortality of patients on maintenance dialysis. It is unknown whether aldosterone and cortisol increase the incidence of sudden cardiac death in dialysis patients.Methods: We analyzed data from 1255 hemodialysis patients with type 2 diabetes mellitus, participating in the German Diabetes and Dialysis Study (4D Study). Aldosterone (<15 pg/mL; 15–100 pg/mL, 100–200 pg/mL, >200 pg/mL), and cortisol (quartiles) were determined at baseline and patients were followed up for a median of 4 years. By Cox regression analyses hazard ratios (HR) were determined for the effect of aldosterone, cortisol and its combination on sudden death and other cardiovascular outcomes.Results: The mean age of the patients was 66±8 years (54% male). The median levels of aldosterone was 15 pg/mL and of cortisol 16.8 μg/dL. Patients with aldosterone levels >200 pg/mL had a significantly higher risk of sudden death (HR 1.69; 95% CI 1.06-2.69) compared to those with an aldosterone <15 pg/mL. The combined presence of high aldosterone (>200 pg/mL) and high cortisol (>21.1 μg/dL) levels increased the risk of sudden cardiac death strikingly compared to patients with low aldosterone (<15 pg/mL) and low cortisol (<13.2 μg/dl) levels (HR 2.86, 95% CI 1.32-6.21). Furthermore, all-cause mortality was significantly increased in the patients with high levels of both hormones (HR 1.62, 95% CI 1.01-2.62).Conclusions: The joint presence of high aldosterone and high cortisol levels strongly increased the incidence of sudden cardiac death as well as all-cause mortality in hemodialyzed type 2 diabetic patients. Whether blockade of the mineralocorticoid receptor decreases the risk of sudden death without causing side effects must be examined in future trials