Sudden cardiac death in non-dialysis chronic kidney disease patients

Abstract

Background: A relatively high proportion of deaths in dialysis patients occur suddenly and unexpectedly. The incidence of sudden cardiac death (SCD) in non-dialysis advanced chronic kidney disease (CKD) stages has been less well investigated. Objective: This study aims to determine the incidence and predictors of SCD in a cohort of 1078 patients with CKD not yet on dialysis. Methods: Prospective observational cohort study, which included patients with advanced CKD not yet on dialysis (stage 4–5). The association between baseline variables and SCD was assessed using Cox and competing-risk (Fine and Gray) regression models. Demographic, clinical information, medication use, and baseline biochemical parameters of potential interest were included as covariates. Results: During the study period (median follow-up time 12 months), 210 patients died (19%), and SCD occurred in 34 cases (16% of total deaths). All-cause mortality and SCD incidence rates were 113 (95% CI: 99–128), and 18 (95% CI: 13–26) events per 1000 patient-years respectively. By Cox regression analysis, covariates significantly associated with SCD were: Age, comorbidity index, and treatment with antiplatelet drugs. This latter covariate showed a beneficial effect over the development of SCD. By competing-risk regression, in which the competing event was non-sudden death from any cause, only age and comorbidity index remained significantly associated with SCD. Conclusions: SCD is relatively common in non-dialysis advanced CKD patients. SCD was closely related to age and comorbidity, and some indirect data from this study suggest that unrecognized or undertreated cardiovascular disease may predispose to a higher risk of SCD.

Keywords

• Chronic kidney disease
• Pre-dialysis
• Sudden cardiac death
• Mortality
• Cardiovascular risk