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Association between Clinical and Doppler Echocardiographic Parameters with Sudden Death in Hemodialysis Patients
Silvio Henrique Barberato1, Sérgio Gardano Elias Bucharles2, Marcia Ferreira Alves Barberato1
1Centro de Diagnóstico Cardiovascular, Curitiba, PR, Brazil.
Insights
Sudden cardiac death (SCD) in hemodialysis (HD) patients is linked to diabetes and increased left ventricular mass. Addressing these factors may reduce SCD risk in HD populations.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Sudden cardiac death (SCD) is a primary cause of mortality among patients undergoing maintenance hemodialysis (HD).
- Limited data exists on the specific risk factors contributing to SCD in this vulnerable patient group.
Purpose of the Study:
- To investigate the association between clinical and echocardiographic variables and SCD in patients on chronic HD.
- Identify independent predictors of SCD in the HD population.
Main Methods:
- A retrospective nested case-control study design was employed.
- Patients on chronic HD were prospectively followed to ascertain SCD events.
- Multivariate logistic regression analysis was used to identify independent predictors of SCD.
Main Results:
- Diabetes mellitus and elevated left ventricular mass index (LVMI ≥ 101 g/m2.7) were independently associated with SCD.
- Patients experiencing SCD showed higher prevalence of prior heart failure, myocardial infarction, and diabetes, alongside greater left atrial size and reduced global myocardial performance compared to controls.
- No significant differences were observed in time on dialysis, traditional biochemical markers, blood pressure, smoking status, cardiovascular drug use, ejection fraction, or diastolic function between SCD and control groups.
Conclusions:
- Diabetes mellitus and left ventricular hypertrophy (LVH) are significant risk factors for SCD in HD patients.
- Targeted preventive and therapeutic strategies focusing on diabetes and LVH are crucial for reducing SCD incidence in this population.
Background:
Sudden cardiac death (SCD) is the leading cause of death in maintenance hemodialysis (HD) patients, but there is little information about underlying risk factors.
Objectives:
Evaluate the association between clinical and echocardiographic variables with SCD on HD patients.
Methods:
Retrospective nested case-control study on chronic HD patients who were prospectively followed. The primary endpoint was SCD. Variables were compared by Student t test, Mann-Whitney or Chi-Square, and independent predictors of SCD were evidenced by multivariate logistic regression.
Results:
We followed 153 patients (50 ± 15 years, 58% men) for 23 ± 14 months and observed 35 deaths, 17 of which were SCD events. When compared to the control group (matched for gender, age, and body mass index) there were no differences regarding time on dialysis, traditional biochemical parameters, blood pressure, smoking, use of cardiovascular protective drugs, ejection fraction, left ventricular dimensions, and diastolic function indices. On the other hand, in the SCD group, we found a higher prevalence of previous heart failure, acute myocardial infarction and diabetes, greater left ventricular mass index, greater left atrial size and lower global myocardial performance. After multivariate logistic regression analysis, diabetes (OR = 2.6; CI = 1.3-7.5; p = 0.023) and left ventricular mass index ≥ 101 g/m2.7 (OR = 1.04; CI = 1.01-1.08; p = 0.028) showed independent association with SCD events.
Conclusions:
HD patients with diabetes mellitus and left ventricular hypertrophy appear to have the highest risk of SCD. Preventive and therapeutic strategies should be encouraged in addressing these risk factors to minimize the occurrence of SCD in HD patients.
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