Moderate Kidney Dysfunction Independently Increases Sudden Cardiac Arrest Risk: A Community-Based Study

Moderate kidney dysfunction is independently associated with increased cardiovascular death. Sudden cardiac arrest (SCA) accounts for at least 25% of chronic kidney disease (CKD) death. This study aimed to evaluate the impact of moderate CKD on SCA risk.

We conducted a case-control study within a community-based investigation of SCA in the Portland, Oregon, metropolitan area from February 1, 2002, to December 31, 2020. Analysis included individuals aged 40 to 75 years who experienced SCA (cases) and individuals with no history of SCA (controls), with creatinine levels measured before SCA/enrollment. Moderate CKD was defined by an estimated glomerular filtration rate of 30 to <60 mL/min per 1.73 m² (2021 Chronic Kidney Disease Epidemiology Collaboration formula). A population-based SCA study in southern California was used for validation.

We compared 2068 SCA cases and 852 controls (mean ages, 61.4±8.5 and 62.7±8.0 years, respectively; men: 69.9% and 67.4%, respectively). SCA cases had more moderate CKD (17.7% versus 14.7%, P<0.001) and lower estimated glomerular filtration rate (74.7 versus 80.9 mL/min per 1.73 m², P<0.001) than controls. Multivariable regression demonstrated that moderate CKD was an independent risk factor for SCA (odds ratio, 1.32 [95% CI, 1.02-1.71]). Each 10 mL/min per 1.73 m² estimated glomerular filtration rate drop to <90 increased SCA risk (odds ratio, 1.24 [95% CI, 1.18-1.31]). Similar findings were observed in the validation cohort (817 SCA and 3249 controls), where moderate CKD was associated with SCA (odds ratio, 1.54 [95% CI, 1.18-2.00]).

Moderate CKD is associated with an increased risk of SCA in the general population. Further research into the potential integration of moderate renal dysfunction into SCA risk stratification are warranted.