title: Association between Clinical and Doppler Echocardiographic Parameters with Sudden Death in Hemodialysis Patients.
abstract: BACKGROUND
  Sudden cardiac death (SCD) is the leading cause of death in maintenance hemodialysis (HD) patients, but there is little information about underlying risk factors.
  
  
  OBJECTIVE
  Evaluate the association between clinical and echocardiographic variables with SCD on HD patients.
  
  
  METHODS
  Retrospective nested case-control study on chronic HD patients who were prospectively followed. The primary endpoint was SCD. Variables were compared by Student t test, Mann-Whitney or Chi-Square, and independent predictors of SCD were evidenced by multivariate logistic regression.
  
  
  RESULTS
  We followed 153 patients (50 ± 15 years, 58% men) for 23 ± 14 months and observed 35 deaths, 17 of which were SCD events. When compared to the control group (matched for gender, age, and body mass index) there were no differences regarding time on dialysis, traditional biochemical parameters, blood pressure, smoking, use of cardiovascular protective drugs, ejection fraction, left ventricular dimensions, and diastolic function indices. On the other hand, in the SCD group, we found a higher prevalence of previous heart failure, acute myocardial infarction and diabetes, greater left ventricular mass index, greater left atrial size and lower global myocardial performance. After multivariate logistic regression analysis, diabetes (OR = 2.6; CI = 1.3-7.5; p = 0.023) and left ventricular mass index ≥ 101 g/m2.7 (OR = 1.04; CI = 1.01-1.08; p = 0.028) showed independent association with SCD events.
  
  
  CONCLUSIONS
  HD patients with diabetes mellitus and left ventricular hypertrophy appear to have the highest risk of SCD. Preventive and therapeutic strategies should be encouraged in addressing these risk factors to minimize the occurrence of SCD in HD patients.
authors.affiliation: Centro de Diagnóstico Cardiovascular, Curitiba, PR, Brazil.
authors.forename: Silvio Henrique
authors.initials: SH
authors.lastname: Barberato
authors.affiliation: Fundação Pró Renal, Curitiba, PR, Brazil.
authors.forename: Sérgio Gardano Elias
authors.initials: SG
authors.lastname: Bucharles
authors.affiliation: Centro de Diagnóstico Cardiovascular, Curitiba, PR, Brazil.
authors.forename: Marcia Ferreira Alves
authors.initials: MF
authors.lastname: Barberato
authors.affiliation: Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pecoits-Filho
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D048909:Diabetes Complications; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors