title: Aldosterone and cortisol affect the risk of sudden cardiac death in haemodialysis patients.
abstract: BACKGROUND
  Sudden cardiac death is common and accounts largely for the excess mortality of patients on maintenance dialysis. It is unknown whether aldosterone and cortisol increase the incidence of sudden cardiac death in dialysis patients.
  
  
  RESULTS
  We analysed data from 1255 diabetic haemodialysis patients participating in the German Diabetes and Dialysis Study (4D Study). Categories of aldosterone and cortisol were determined at baseline and patients were followed for a median of 4 years. By Cox regression analyses, hazard ratios (HRs) were determined for the effect of aldosterone, cortisol, and their combination on sudden death and other adjudicated cardiovascular outcomes. The mean age of the patients was 66 ± 8 years (54% male). Median aldosterone was <15 pg/mL (detection limit) and cortisol 16.8 µg/dL. Patients with aldosterone levels >200 pg/mL had a significantly higher risk of sudden death (HR: 1.69; 95% CI: 1.06-2.69) compared with those with an aldosterone <15 pg/mL. The combined presence of high aldosterone (>200 pg/mL) and high cortisol (>21.1 µg/dL) levels increased the risk of sudden death in striking contrast to patients with low aldosterone (<15 pg/mL) and low cortisol (<13.2 µg/dL) levels (HR: 2.86, 95% CI: 1.32-6.21). Furthermore, all-cause mortality was significantly increased in the patients with high levels of both hormones (HR: 1.62, 95% CI: 1.01-2.62).
  
  
  CONCLUSIONS
  The joint presence of high aldosterone and high cortisol levels is strongly associated with sudden cardiac death as well as all-cause mortality in haemodialysed type 2 diabetic patients. Whether a blockade of the mineralocorticoid receptor decreases the risk of sudden death in these patients must be examined in future trials.
authors.affiliation: Division of Nephrology, Department of Internal Medicine 1, University Hospital Würzburg, University of Würzburg, Oberdürrbacherstr. 6, D-97080, Würzburg, Germany. drechsler_c@medizin.uni-wuerzburg.de
authors.forename: Christiane
authors.initials: C
authors.lastname: Drechsler
authors.forename: Eberhard
authors.initials: E
authors.lastname: Ritz
authors.forename: Andreas
authors.initials: A
authors.lastname: Tomaschitz
authors.forename: Stefan
authors.initials: S
authors.lastname: Pilz
authors.forename: Stephan
authors.initials: S
authors.lastname: Schönfeld
authors.forename: Katja
authors.initials: K
authors.lastname: Blouin
authors.forename: Martin
authors.initials: M
authors.lastname: Bidlingmaier
authors.forename: Fabian
authors.initials: F
authors.lastname: Hammer
authors.forename: Vera
authors.initials: V
authors.lastname: Krane
authors.forename: Winfried
authors.initials: W
authors.lastname: März
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
authors.forename: Martin
authors.initials: M
authors.lastname: Fassnacht
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000378:metabolism*; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000069059:Atorvastatin; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004357:Drug Synergism; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011758:Pyrroles / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D011758:Pyrroles; D000450:Aldosterone; D000069059:Atorvastatin; D006854:Hydrocortisone