Premium
Sudden cardiac death in haemodialysis patients: Preventative options
Author(s) -
Chiu Diana Yuan Yng,
Sinha Smeeta,
Kalra Philip A,
Green Darren
Publication year - 2014
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12337
Subject(s) - medicine , sudden cardiac death , dialysis , population , disease , intensive care medicine , cardiology , cause of death , left ventricular hypertrophy , etiology , hemodialysis , end stage renal disease , kidney disease , sudden death , pathological , blood pressure , environmental health
Sudden cardiac death ( SCD ) is the most common cause of death in haemodialysis patients, accounting for 25% of all‐cause mortality. There are many potential pathological precipitants as most patients with end‐stage renal disease have structurally or functionally abnormal hearts. For example, at initiation of dialysis, 74% of patients have left ventricular hypertrophy. The pathophysiological and metabolic milieu of patients with end‐stage renal disease, allied to the regular stresses of dialysis, may provide the trigger to a fatal cardiac event. Prevention of SCD can be seen as a legitimate target to improve survival in this patient group. In the general population, this is most effective by reducing the burden of ischaemic heart disease. However, the aetiology of SCD in haemodialysis patients appears to be different, with myocardial fibrosis, vascular calcification and autonomic dysfunction implicated as possible causes. Thus, the range of therapies is different to the general population. There are potential preventative measures emerging as our understanding of the underlying mechanisms progresses. This article aims to review the evidence for therapies to prevent SCD effective in the general population when applied to dialysis patients, as well as promising new treatments specific to this population group.