Sudden cardiac arrest in end-stage renal disease patients on dialysis: A nationwide study

Sudden cardiac arrest (SCA) is frequently encountered in end-stage renal disease (ESRD) patients on dialysis. There is a dearth of national data on SCA-associated outcomes in this specific patient population. The aim of the present study is to study these parameters from a nationally representative US population.

Data were extracted from National Inpatient Sample database from October 2005 to December 2014. All patients with clinical encounter of dialysis during the study period were enrolled. Patients who underwent SCA, ventricular fibrillation, ventricular tachycardia, and ventricular flutter were then identified by applying relevant International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients with acute kidney injury and prior renal transplant were excluded. Propensity matching was done to balance covariates among study groups. Logistic regression analysis was done to assess for predictors of SCA-associated mortality in ESRD patients on dialysis.

A total of 1 147 760 patients were included in the final analyses. Patients who suffered SCA were older when compared to the non-SCA cohort and had a higher burden of comorbidities. About half (52.10%) of ESRD patients who suffered SCA died. Advanced age, metabolic acidosis, and cardiogenic shock were independently associated with reduced survival after SCA. New implantable cardioverter defibrillator implantation continues to be low in this patient population at discharge.

SCA in settings of ESRD on dialysis carries high mortality and frequent morbidity. Further research in therapeutic interventions that could prevent SCA in this vulnerable population is utmost needed.