title: Predictors of sudden cardiac death: a competing risk approach in the hemodialysis study.
abstract: OBJECTIVE
  There are few data on risk factors for sudden cardiac death (SCD) in patients undergoing hemodialysis (HD). The study objective was to identify predictors associated with various causes of death in the Hemodialysis (HEMO) Study and to develop a prediction model for SCD using a competing risk approach.
  
  
  METHODS
  In this analysis of 1745 HEMO participants, all-cause mortality was classified as SCD, non-SCD, and noncardiac death. Predictors for each cause of death were evaluated using cause-specific Cox proportional hazards models, and a competing risk approach was used to calculate absolute risk predictions for SCD.
  
  
  RESULTS
  During a median follow-up of 2.5 years, 808 patients died. Rates of SCD, non-SCD, and noncardiac death were 22%, 17%, and 61%, respectively. Predictors of various causes of death differ somewhat in HD patients. Age, diabetes, peripheral vascular disease, ischemic heart disease, serum creatinine, and alkaline phosphatase were independent predictors of SCD. The 3-year C-statistic for SCD was 0.75 (95% confidence interval, 0.70-0.79), and calibration was good (χ(2)=1.1; P=0.89). At years 3 and 5 of follow-up, the standard Cox model overestimated the risk for SCD as compared with the competing risk approach on the relative scale by 25% and 46%, respectively, and on the absolute scale by 2% and 6%, respectively.
  
  
  CONCLUSIONS
  Predictors of various causes of death differ in HD patients. The proposed prediction model for SCD accounts for competing causes of death. External validation of this model is required.
authors.affiliation: Division of Nephrology, Tufts Medical Center, 800 Washington Street, Box 391, Boston, MA 02111, USA.
authors.forename: Shani
authors.initials: S
authors.lastname: Shastri
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.forename: Hocine
authors.initials: H
authors.lastname: Tighiouart
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Beck
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Vlagopoulos
authors.forename: Daniel
authors.initials: D
authors.lastname: Ornt
authors.forename: Garabed
authors.initials: G
authors.lastname: Eknoyan
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Charles
authors.initials: C
authors.lastname: Herzog
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Cheung
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D000368:Aged; D002138:Calibration; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects*; D012306:Risk
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