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Coronary Artery Disease and Sudden Unexplained Death in Patients on Dialysis: A Propensity Score-Matched Cohort Study

Jose Jayme G De Lima1, Luis Henrique W Gowdak1, José Otto Reusing2

  • 1Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.

American Journal of Hypertension
|June 11, 2025
PubMed

Insights

Coronary artery disease (CAD) did not significantly increase sudden unexplained death (SUD) risk in dialysis patients. However, coronary intervention reduced SUD risk by 59% in those with severe CAD.

Area of Science:

  • Cardiology
  • Nephrology
  • Transplantation

Background:

  • Dialysis patients face elevated risks for cardiovascular events and sudden death.
  • Coronary artery disease (CAD) is common in this population, but its direct link to sudden unexplained death (SUD) requires clarification.

Purpose of the Study:

  • To investigate the association between CAD and SUD in patients undergoing dialysis and coronary angiography.
  • To evaluate the impact of coronary intervention on SUD risk in this patient group.

Main Methods:

  • Coronary angiography was performed on 1,044 dialysis patients using propensity-match analysis.
  • Patients were grouped based on the presence or absence of significant CAD.
  • Logistic regression and survival analysis (Aalen-Johansen method) were used to assess outcomes.

Main Results:

  • Coronary artery disease (CAD) was not significantly associated with an increased risk of sudden unexplained death (SUD) (HR 1.37, P=0.21).
  • Among patients who underwent coronary intervention, there was a significant 59% reduction in the risk of SUD (HR 0.41, P=0.002).

Conclusions:

  • CAD is not directly linked to SUD in dialysis patients undergoing angiography.
  • Coronary intervention significantly reduces SUD incidence in dialysis patients with severe CAD.
  • Invasive assessment for CAD may be beneficial for identifying and treating high-risk dialysis patients to prevent SUD.
Abstract

Keywords:
blood pressurechronic kidney diseasecoronary artery diseasehemodialysishypertensionsudden death

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