Key Points
- Evaluate the incidence, etiology, and mortality of sudden cardiac arrest in dialysis patients to establish the rationale for mandated on-site defibrillation capabilities.
- Synthesized epidemiological data from the United States Renal Data System (USRDS) cohort (including 130,379 diabetic ESRD incident patients from 1995–1999) and published registry studies.
- Analyzed regional ambulance response records and clinical series reporting survival after cardiac arrest and cardiopulmonary resuscitation in outpatient dialysis centers.
- Cardiac disease causes 43% of all-cause dialysis mortality, with cardiac arrest or arrhythmia responsible for 61% of all cardiac deaths.
- In diabetic ESRD patients surviving one year, cardiac arrest rates rose from 110 per 1,000 patient-years at year two to 208 per 1,000 patient-years at year five, reaching a cumulative 5-year risk of at least 50%.
- Ventricular fibrillation or tachycardia occurred in 62% (29/47) of dialysis clinic arrests, with defibrillation yielding 38% discharge survival compared to under 10% survival when rapid defibrillation was unavailable.
Structured PICO
PPopulationDialysis patients (end-stage renal disease) at high risk for sudden cardiac death
IInterventionAutomatic external defibrillators (AEDs) available in dialysis centers
Given the high incidence of sudden cardiac death in dialysis patients, the mandatory availability of automatic external defibrillators (AEDs) in dialysis units is a logical and necessary step to improve survival.