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August 23, 2026Journal of Internal MedicineOpen Access

SCD accounts for ~33% of all hemodialysis deaths, driven equally by bradyarrhythmias and tachyarrhythmias.

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Why the study?

Recent device-based studies challenge traditional paradigms of SCD in CKD by revealing a heterogeneous arrhythmic spectrum, necessitating a shift from descriptive epidemiology to mechanism-driven prevention.

Design

Narrative, non-systematic review

Key result

Sudden cardiac death accounts for roughly 25% to 33% of all deaths and up to 60% to 75% of cardiovascular mortality in hemodialysis, with bradyarrhythmias as frequent as tachyarrhythmias.

Authors

CZCarmine ZoccaliMKMehmet KanbayAWAndrzej Więcek

Discussion

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Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

HSHan Sean LeeRenal medicine, Salford Royal Hospital/University of Manchester

“Zoccali et al. provide a timely and comprehensive review of this challenging field with recommendations that will help better understand phenotype, pathophysiology and lead toward appropriate intervention in high-risk individuals.”

Editorial

Overview

Temporal clustering of SCD around interdialytic intervals warrants targeted surveillance in hemodialysis; extends prior epidemiology via systematic synthesis.

Key Points

  • To synthesize epidemiologic, mechanistic, and interventional evidence on sudden cardiac death across chronic kidney disease stages and dialysis to construct a framework for mechanism-driven prevention.
  • Conducted a narrative, non-systematic review evaluating epidemiologic studies, device-based monitoring cohorts (implantable loop recorders and cardioverter-defibrillators), and clinical trials.
  • Assessed modifiable pharmacologic, dialytic, and device therapies across three domains: myocardial substrate, electrophysiologic milieu, and dialytic triggers.
  • Sudden cardiac death accounts for roughly 25% to 33% of all deaths and 60% to 75% of cardiovascular mortality in hemodialysis, clustering around the long interdialytic interval.
  • Continuous rhythm monitoring demonstrates that bradyarrhythmias, pauses, and conduction disease occur at least as frequently as sustained ventricular tachycardia or ventricular fibrillation.
  • Preventive strategies integrate heart failure pharmacotherapies (SGLT2 inhibitors, ARNi, MRA, beta-blockers), tailored dialysate prescriptions (potassium, calcium, bicarbonate, ultrafiltration rate), and selective device therapy.

Structured PICO

P
Population
Patients across the chronic kidney disease (CKD) continuum, particularly those with dialysis-dependent kidney failure
O
Outcome
Sudden cardiac death (SCD)hard clinical

This review highlights that sudden cardiac death in dialysis patients is frequently caused by bradyarrhythmias and conduction disease rather than just ventricular tachyarrhythmias, necessitating a multifaceted prevention approach involving medical therapy, dialysis optimization, and device therapy.

Limitations

  • Methodological challenges in defining and adjudicating SCD in CKD

Cite This Study

Zoccali et al. (2026) conducted a review in Chronic kidney disease and dialysis. Sudden cardiac death accounts for roughly 25% to 33% of all deaths and up to 60% to 75% of cardiovascular mortality in hemodialysis, with bradyarrhythmias as frequent as tachyarrhythmias.

synapsesocial.com/papers/6a8aada77677a34114445ecahttps://doi.org/10.1111/joim.70127
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