title: Sudden cardiac death in haemodialysis patients: preventative options.
abstract: Sudden cardiac death (SCD) is the most common cause of death in haemodialysis patients, accounting for 25% of all-cause mortality. There are many potential pathological precipitants as most patients with end-stage renal disease have structurally or functionally abnormal hearts. For example, at initiation of dialysis, 74% of patients have left ventricular hypertrophy. The pathophysiological and metabolic milieu of patients with end-stage renal disease, allied to the regular stresses of dialysis, may provide the trigger to a fatal cardiac event. Prevention of SCD can be seen as a legitimate target to improve survival in this patient group. In the general population, this is most effective by reducing the burden of ischaemic heart disease. However, the aetiology of SCD in haemodialysis patients appears to be different, with myocardial fibrosis, vascular calcification and autonomic dysfunction implicated as possible causes. Thus, the range of therapies is different to the general population. There are potential preventative measures emerging as our understanding of the underlying mechanisms progresses. This article aims to review the evidence for therapies to prevent SCD effective in the general population when applied to dialysis patients, as well as promising new treatments specific to this population group.
authors.affiliation: Vascular Research Group, Manchester Academic Health Sciences Centre, Institute of Population Health, The University of Manchester, Manchester, UK; Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Diana Yuan Yng
authors.initials: DY
authors.lastname: Chiu
authors.forename: Smeeta
authors.initials: S
authors.lastname: Sinha
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
authors.forename: Darren
authors.initials: D
authors.lastname: Green
mesh_terms: D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors
keywords: cardiac; death; dialysis; sudden; therapeutics