Sudden cardiac death in non-dialysis chronic kidney disease patients.
BACKGROUND
A relatively high proportion of deaths in dialysis patients occur suddenly and unexpectedly. The incidence of sudden cardiac death (SCD) in non-dialysis advanced chronic kidney disease (CKD) stages has been less well investigated.


OBJECTIVE
This study aims to determine the incidence and predictors of SCD in a cohort of 1078 patients with CKD not yet on dialysis.


METHODS
Prospective observational cohort study, which included patients with advanced CKD not yet on dialysis (stage 4-5). The association between baseline variables and SCD was assessed using Cox and competing-risk (Fine and Grey) regression models. Demographic, clinical information, medication use, and baseline biochemical parameters of potential interest were included as covariates.


RESULTS
During the study period (median follow-up time 12 months), 210 patients died (19%), and SCD occurred in 34 cases (16% of total deaths). All-cause mortality and SCD incidence rates were 113 (95% CI: 99-128), and 18 (95% CI: 13-26) events per 1000 patients/year, respectively. By Cox regression analysis, covariates significantly associated with SCD were: Age, comorbidity index, and treatment with antiplatelet drugs. This latter covariate showed a beneficial effect over the development of SCD. By competing-risk regression, in which the competing event was non-sudden death from any cause, only age and comorbidity index remained significantly associated with SCD.


CONCLUSIONS
SCD is relatively common in non-dialysis advanced CKD patients. SCD was closely related to age and comorbidity, and some indirect data from this study suggest that unrecognised or undertreated cardiovascular disease may predispose to a higher risk of SCD.
Departamento de Nefrología, Hospital Infanta Cristina, Badajoz, España. Electronic address: fcaravacam@senefro.org.
Francisco
F
Caravaca
Departamento de Nefrología, Hospital Infanta Cristina, Badajoz, España.
Edgar
E
Chávez
Departamento de Nefrología, Hospital Infanta Cristina, Badajoz, España.
Raúl
R
Alvarado
Departamento de Nefrología, Hospital Infanta Cristina, Badajoz, España.
Guadalupe
G
García-Pino
Departamento de Nefrología, Hospital Infanta Cristina, Badajoz, España.
Enrique
E
Luna
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies
D000959:Antihypertensive Agents; D006397:Hematinics; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors
Cardiovascular risk; Chronic kidney disease; Enfermedad renal crónica; Mortalidad; Mortality; Muerte cardíaca súbita; Pre-dialysis; Prediálisis; Riesgo cardiovascular; Sudden cardiac death