Unexplained sudden death in patients on the waiting list for renal transplantation.
BACKGROUND
The incidence of unexplained sudden death (SD) and the factors involved in its occurrence in patients with chronic kidney disease are not well known.


METHODS
We investigated the incidence and the role of co-morbidities in unexplained SD in 1139 haemodialysis patients on the renal transplant waiting list.


RESULTS
Forty-four patients died from SD of undetermined causes (20% of all deaths; 3.9 deaths/1000 patients per year), while 178 died from other causes and 917 survived. SD patients were older and likely to have diabetes, hypertension, past/present cardiovascular disease, higher left ventricular mass index, and lower ejection fraction. Multivariate analysis showed that cardiovascular disease of any type was the only independent predictor of SD (P = 0.0001, HR = 2.13, 95% CI 1.46-3.22). Alterations closely associated with ischaemic heart disease like angina, previous myocardial infarction and altered myocardial scan were not independent predictors of SD. The incidence of unexplained SD in these haemodialysis patients is high and probably a consequence of pre-existing cardiovascular disease.


CONCLUSIONS
Factors influencing SD in dialysis patients are not substantially different from factors in the general population. The role played by ischaemic heart disease in this context needs further evaluation.
De Lima
Jose Jayme Galvão
JJ
Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Brazil. jose.lima@incor.usp.br
Gowdak
Luis Henrique Wolff
LH
de Paula
Flavio Jota
FJ
Arantes
Rodolfo Leite
RL
César
Luiz Antonio Machado
LA
Ramires
Jose Antonio Franchini
JA
Krieger
Eduardo M
EM
D002318:Cardiovascular Diseases; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D014850:Waiting Lists