Key Points
- Synthesize the epidemiological patterns, underlying pathophysiology, clinical risk factors, and diagnostic assessment tools for ventricular arrhythmias and sudden cardiac death in patients with end-stage renal disease undergoing maintenance hemodialysis.
- Synthesized observational registry data from the United States Renal Data System alongside clinical studies evaluating cardiovascular and arrhythmic mortality across hemodialysis and peritoneal dialysis cohorts.
- Reviewed pathophysiological investigations analyzing myocardial structural changes, including left ventricular hypertrophy, arterial stiffness, diminished coronary reserve, and interstitial fibrosis.
- Evaluated diagnostic methods including signal-averaged electrocardiography for cardiac late potentials and assessed acute electrophysiological disruptions caused by intermittent fluid and electrolyte shifts.
- Cardiovascular disease accounts for 40% of deaths in chronic hemodialysis patients, with cardiac arrest and ventricular arrhythmias causing over 20% of all cardiac-related fatalities.
- Left ventricular hypertrophy affects up to 75% of new end-stage renal disease patients, with systolic blood pressure (p < 0.01) and age (p < 0.05) independently predicting complex ventricular arrhythmias.
- Intermittent dialysis induces sharp fluctuations in circulating volume, potassium, and magnesium, exacerbating QT dispersion and myocardial ischemia to heighten arrhythmic vulnerability during and immediately after sessions.
Structured PICO
PPopulationPatients with end-stage renal disease (ESRD) on chronic maintenance hemodialysis (HD)
This review highlights that ESRD patients on hemodialysis face a significantly elevated risk of cardiovascular mortality, particularly from ventricular arrhythmias and sudden cardiac death, driven by factors like left ventricular hypertrophy, hypertension, and anemia.