Elevated pulmonary artery pressure (HR 5.99, p=0.05) and mitral regurgitation (HR 6.71, p=0.01) were independently predictive of sudden cardiac death in dialysis patients.
Cohort (n=323)
Do ECG and echocardiographic abnormalities predict all-cause mortality, cardiovascular mortality, and sudden cardiac death in dialysis patients?
Elevated pulmonary artery pressure and mitral regurgitation on echocardiography are strong independent predictors of sudden cardiac death in dialysis patients, highlighting the need for population-specific risk stratification.
Effect estimate: HR 5.99
p-value: p=0.05
BACKGROUND: Cardiovascular mortality is greater in dialysis patients than the general population. More specifically, sudden cardiac death (SCD) accounts for 26% of dialysis patient deaths. However, SCD risk assessment tools used in the general population are not adequate for dialysis patients indicating that the hierarchy of pathopysiological factors appears to be different. The aim of this study was to use simple bedside tests to determine parameters independently predictive of cardiovascular mortality and SCD in dialysis patients. METHOD AND RESULTS: This was a sub-study of the Chronic Renal Insufficient Standards Implementations Study, a longitudinal cohort study of outcomes in CKD. ECG and echocardiographic abnormalities were assessed in a cross-section of prevalent dialysis patients. Patients were followed up until death or transplantation. Forward stepwise Cox regression then determined factors independently associated with all-cause, cardiovascular and SCD mortality. 323 patients were included (age 61.5 ± 14.6 years, 113 deaths, 66 cardiovascular deaths, 18 SCD). A number of factors were independently associated with all-cause mortality. These were age, time on dialysis, smoking, the difference between QRS and T-wave axes, resting heart rate, and pulmonary artery pressure (PAP) >35 mmHg. The only parameters predictive of SCD were elevated PAP (HR = 5.99, p = 0.05) and mitral regurgitation (HR = 6.71, p = 0.01). CONCLUSION: That PAP is associated with SCD in dialysis patients demonstrates that the pathophysiological mechanism is likely to be different in these patients compared to the general population. Because of this, a population specific approach to risk stratification is advisable.
Green et al. (Thu,) conducted a cohort in Dialysis (n=323). ECG and echocardiographic abnormalities (elevated pulmonary artery pressure and mitral regurgitation) was evaluated on Sudden cardiac death (HR 5.99, p=0.05). Elevated pulmonary artery pressure (HR 5.99, p=0.05) and mitral regurgitation (HR 6.71, p=0.01) were independently predictive of sudden cardiac death in dialysis patients.
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