Renal impairment is an independent risk factor for sudden cardiac death from the early stages of chronic kidney disease, with risk increasing as renal function declines.
Renal impairment independently increases the risk of sudden cardiac death, highlighting the need for improved noninvasive risk stratification, particularly during dialysis.
The review discusses the epidemiology and the possible underlying mechanisms of sudden cardiac death (SCD) in chronic kidney disease (CKD), and highlights the unmet clinical need for noninvasive risk stratification strategies in these patients. Although renal dysfunction shares common risk factors and often coexists with atherosclerotic cardiovascular disease, the presence of renal impairment increases the risk of arrhythmic complications to an extent that cannot be explained by the severity of the atherosclerotic process. Renal impairment is an independent risk factor for SCD from the early stages of CKD; the risk increases as renal function declines and reaches very high levels in patients with end-stage renal disease on dialysis. Autonomic imbalance, uremic cardiomyopathy, and electrolyte disturbances likely play a role in increasing the arrhythmic risk and can be potential targets for treatment. Cardioverter defibrillator treatment could be offered as lifesaving treatment in selected patients, although selection strategies for this treatment mode are presently problematic in dialyzed patients. The review also examines the current experience with risk stratification tools in renal patients and suggests that noninvasive electrophysiological testing during dialysis may be of clinical value as it provides the necessary standardized environment for reproducible measurements for risk stratification purposes.
Poulikakos et al. (Wed,) conducted a review in Chronic Kidney Disease and Sudden Cardiac Death. Renal impairment is an independent risk factor for sudden cardiac death from the early stages of chronic kidney disease, with risk increasing as renal function declines.