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Sudden cardiac death in non-dialysis chronic kidney disease patients

Francisco Caravaca¹, Edgar Chávez¹, Raúl Alvarado¹

¹Departamento de Nefrología, Hospital Infanta Cristina, Badajoz, España.

Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia

|June 9, 2016

Insights

Sudden cardiac death (SCD) is common in advanced chronic kidney disease (CKD) patients not on dialysis. Age and comorbidity index are key predictors of SCD risk in this population.

Area of Science:

Nephrology
Cardiology
Public Health

Background:

Sudden cardiac death (SCD) is a significant cause of mortality in dialysis patients.
The incidence and predictors of SCD in advanced chronic kidney disease (CKD) stages prior to dialysis initiation are less understood.

Purpose of the Study:

To determine the incidence and identify predictors of SCD in patients with advanced CKD (stages 4-5) not yet on dialysis.
To investigate the association between baseline variables and SCD risk.

Main Methods:

Prospective observational cohort study of 1078 patients with advanced CKD (stage 4-5) not on dialysis.
Utilized Cox and competing-risk (Fine and Grey) regression models to assess the association between baseline variables and SCD.
Included demographic, clinical, medication, and biochemical parameters as covariates.

Main Results:

Over a median follow-up of 12 months, 210 deaths occurred, with 34 (16%) being SCD.
The incidence rates were 113 deaths per 1000 patient-years for all-cause mortality and 18 per 1000 patient-years for SCD.
Cox regression identified age, comorbidity index, and antiplatelet drug use (protective effect) as significant SCD predictors. Competing-risk analysis confirmed age and comorbidity index.

Conclusions:

SCD is a prevalent event in advanced CKD patients not yet on dialysis.
Age and comorbidity index are strongly associated with SCD risk.
Underlying cardiovascular disease may contribute to increased SCD risk in this patient group.

Read full analysis

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 Grey) 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 patients/year, 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 unrecognised or undertreated cardiovascular disease may predispose to a higher risk of SCD.

Keywords:

Cardiovascular risk Chronic kidney disease Enfermedad renal crónica Mortalidad Mortality Muerte cardíaca súbita Pre-dialysis Prediálisis Riesgo cardiovascular Sudden cardiac death

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