A17(Th)
PREDIALYSIS CHRONIC KIDNEY DISEASE AS A RISK FOR SUDDEN CARDIAC DEATH
Polikakos, D, Rapley, W, Mohajer Bastami, A, Baboonian, C, Banerjee, D
Division of Clinical Sciences St Georges, University of London
INTRODUCTION: Sudden cardiac death [SCD] is a common cause of mortality in the End Stage Kidney
Disease patients. Cardiovascular events are frequent in predialysis Chronic Kidney Disease [CKD]; but the rate
of SCD in patients with predialysis CKD is unknown. If the rate of SCD in CKD is high; the issue merits further
investigation to prevent SCD in this large number of patients, approximately 10% of the general population.
AIMS: This study aimed to estimate the rate of SCD in CKD as already reported in the literature.
METHODS: A Medline search was conducted using the following search terms; kidney disease, renal failure,
cardiac death, sudden cardiac death, cardiovascular mortality, sudden death and cardiac mortality. Further studies
were examined as reference from the selected studies.
Table 1 Studies of sudden cardiac death in predialysis CKD
Author/year
N
Stage of Follow Event Hazard Ratio
CKD
up (m) rate SCD in CKD
Goldenberg
1223
3-5
20
1.68
2006
5
2.57
Pun 2009
19440
3+4
65
7.3
1.88
5
12.6
4.68
Deo 2010
4465
3-5
134
27
1.65
Saxon 2006
1520
3-5
15
1.69
Wase 2004
95
3-5
100
2.59
Chonchol 2007
2-5
2.4
Deo 2008
2763
3-5
96
17
3.2
Cuculich 2007
229
3a
18
2.5
3b
7.7
4-5
40
Comments on patients
High risk
High risk,
295 with diabetes
Low risk patients
High risk patients with arrhythmias
High risk patients End Stage Renal Disease
High risk patients with heart failure
Women only study/ high risk CAD
High risk patients with ICD included
RESULTS: Eight studies were identified. The studies were heterogeneous with variable patient numbers [9519,000] & follow up duration [15-100 months] and hence a combined analysis was not possible. Hazard ratio with
CKD was high compared to the non-CKD population. The hazard ratio increased with declining kidney function;
from 1.9 in stage 3/4 to 4.7 in stage 5 [Pun et al 2009]. Most studies included high risk patients such as with
previous CAD with higher hazard ratio 3.2 in stages 3/4 [Deo et al 2008]. The risk was lower than on dialysis
[Cuculich et al 2007].
CONCLUSION: The data presented strongly suggests an association of increasing risk of SCD with CKD.
However, the data is heterogeneous, retrospective and in high risk patients. Further studies of prospective nature
are essential to establish the association between SCD and CKD.
References
1. Chonchol M et al Am J Nephrol 2007;27:7-14.
2. Cuculich PS et al Sanchez PACE 2007;30:207-213.
3. Deo R et al Hypertension 2008;51:1578-1582.
4. Deo R et al Circ Cardiovasc Qual Outcomes 2010;3:159-164.
5. Goldenberg I et al Am J Cardiol 2006;98:485-490.
6. Pun PH et al Kidney International 2009; 76:652-658.
7. Saxon LA et al Circulation 2006; 114:2766-2772.