title: Unexplained sudden death in patients on the waiting list for renal transplantation.
abstract: 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.
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, Brazil. jose.lima@incor.usp.br
authors.forename: Jose Jayme Galvão
authors.initials: JJ
authors.lastname: De Lima
authors.forename: Luis Henrique Wolff
authors.initials: LH
authors.lastname: Gowdak
authors.forename: Flavio Jota
authors.initials: FJ
authors.lastname: de Paula
authors.forename: Rodolfo Leite
authors.initials: RL
authors.lastname: Arantes
authors.forename: Luiz Antonio Machado
authors.initials: LA
authors.lastname: César
authors.forename: Jose Antonio Franchini
authors.initials: JA
authors.lastname: Ramires
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Krieger
mesh_terms: 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