Sudden cardiac death and chronic kidney disease

Abstract

Sudden cardiac death (SCD) is responsible for approximately one fourth of all cause mortality in dialysis patients. In chronic kidney disease (CKD) patients, unlike general population, traditional coronary artery disease associated risk factors are not the major determinants of SCD. The adverse cardiomyopathic and vasculopathic milieu in CKD predispose these patients to arrythmias, conduction abnormalities, and sudden cardiac death. In advanced kidney disease, these conditions may be further exacerbated by electrolyte shifts, divalent ion abnormalities, sympathetic overactivity, decreased baroreflex sensitivity, iron toxicity, and chronic inflammation. The outcomes after cardiac arrest in CKD patients particularly those on dialysis are poor. The decision to implant a cardioverter- defibrillator deppends on the patient's age and stage of CKD. In this review, we will discuss the definition, pathophysiology, risk factors and preventive strategies of SCD in the setting of CKD.

Keywords

• arrythmia
• cardiomyopathy
• hemodialysis
• sudden cardiac death