Sudden death and associated factors in a historical cohort of chronic haemodialysis patients.
BACKGROUND
In haemodialysis patients, deaths due to cardiovascular causes constitute a large proportion of total mortality and sudden cardiac deaths account for approximately 22% of all deaths. The aim of this study was to evaluate the incidence of sudden cardiac death and associated risk factors in a cohort of haemodialysis patients.


RESULTS
The 3-year cumulative incidence of death in a cohort of 476 patients on chronic haemodialysis treatment was 34.3% (SE 2.3). Sudden death had a 6.9% (SE 1.2) cumulative incidence, with 32 events representing 19.2% of all deaths, while cardiovascular not sudden death and noncardiovascular death accounted for a 3-year cumulative incidence of 7.3% (SE 1.2) and 20.1% (SE 1.9), respectively. According to Cox multivariate analysis, significant risk factors for sudden death were the presence of atrial fibrillation, diabetes mellitus, predialytic hyperkalaemia, haemodialysis mode and C-reactive protein level, which were associated with a 2.9 (CI(95%) 1.3-6.4), 3.0 (CI(95%) 1.3-7.2), 2.7 (CI(95%) 1.3-5.8), 4.5 (CI(95%) 1.3-15.5) and 3.3 (CI(95%) 1.2-8.8)-fold increase in the risk of sudden death, respectively. Sudden death was significantly more frequent during the first 24 h of the first short interdialytic interval and during the last 24 h of the long interval, i.e. immediately before and immediately after the first weekly haemodialysis session (P = 0.02).


CONCLUSIONS
Our data show that the incidence of sudden death in haemodialysis patients is high and that atrial fibrillation, diabetes, hyperkalaemia, haemodialysis mode and C-reactive protein play an important role in developing fatal arrhythmia. Further studies will be necessary to define which interventions could be helpful in reducing this cause of mortality.
Genovesi
Simonetta
S
Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Nephrology Unit, San Gerardo Hospital, Monza, Italy. simonetta.genovesi@unimib.it
Valsecchi
Maria G
MG
Rossi
Emanuela
E
Pogliani
Daniela
D
Acquistapace
Irene
I
De Cristofaro
Vincenzo
V
Stella
Andrea
A
Vincenti
Antonio
A
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications; D002097:C-Reactive Protein / Q000378:metabolism; D002423:Cause of Death; D003645:Death, Sudden / Q000209:etiology*; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000150:complications; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D055815:Young Adult
D002097:C-Reactive Protein