Sudden cardiac death in dialysis patients: different causes and management strategies.

Simonetta Genovesi (1, 2) , Giuseppe Boriani (3) , Adrian Covic (4) , Robin W M Vernooij (5, 6) , Christian Combe (7, 8) , Alexandru Burlacu (4) , Andrew Davenport (9) , Mehmet Kanbay (10) , Dimitrios Kirmizis , Daniel Schneditz (11) , Frank van Der Sande (12) , Carlo Basile

1 UNIMIB - Università degli Studi di Milano-Bicocca = University of Milano-Bicocca
2 San Gerardo Hospital
3 Azienda Ospedaleria Universitaria di Modena = University Hospital of Modena
4 UMF lasi - University of Medicine and Pharmacy "Grigore T.Popa" Iasi
5 Universiteit Utrecht / Utrecht University [Utrecht]
6 University Medical Center [Utrecht]
7 BIOTIS - Bioingénierie tissulaire
8 CHU Bordeaux
9 UCL - University College of London [London]
10 Koc University, School of Medicine, Istanbul
11 Medical University of Graz
12 Maastricht University Hospital

Sudden cardiac death (SCD) represents a major cause of death in end-stage kidney disease (ESKD). The precise estimate of its incidence is difficult to establish because studies on the incidence of SCD in ESKD are often combined with those related to sudden cardiac arrest (SCA) occurring during a haemodialysis (HD) session. The aim of the European Dialysis Working Group of ERA-EDTA was to critically review the current literature examining the causes of extradialysis SCD and intradialysis SCA in ESKD patients and potential management strategies to reduce the incidence of such events. Extradialysis SCD and intradialysis SCA represent different clinical situations and should be kept distinct. Regarding the problem, numerically less relevant, of patients affected by intradialysis SCA, some modifiable risk factors have been identified, such as a low concentration of potassium and calcium in the dialysate, and some advantages linked to the presence of automated external defibrillators in dialysis units have been documented. The problem of extra-dialysis SCD is more complex. A reduced left ventricular ejection fraction associated with SCD is present only in a minority of cases occurring in HD patients. This is the proof that SCD occurring in ESKD has different characteristics compared with SCD occurring in patients with ischaemic heart disease and/or heart failure and not affected by ESKD. Recent evidence suggests that the fatal arrhythmia in this population may be due more frequently to bradyarrhythmias than to tachyarrhythmias. This fact may partly explain why several studies could not demonstrate an advantage of implantable cardioverter defibrillators in preventing SCD in ESKD patients. Electrolyte imbalances, frequently present in HD patients, could explain part of the arrhythmic phenomena, as suggested by the relationship between SCD and timing of the HD session. However, the high incidence of SCD in patients on peritoneal dialysis suggests that other risk factors due to cardiac comorbidities and uraemia per se may contribute to sudden mortality in ESKD patients.

Mots clés: Arrhythmias; Cardiac; Death; Sudden; Disease Management; Humans; Kidney Failure; Chronic; Renal Dialysis; Risk Factors; dialysate; end-stage kidney disease; implantable cardiac device; sudden cardiac arrest; sudden cardiac death

Domaines: Urologie et Néphrologie

Simonetta Genovesi, Giuseppe Boriani, Adrian Covic, Robin W M Vernooij, Christian Combe, et al.. Sudden cardiac death in dialysis patients: different causes and management strategies.. Nephrology Dialysis Transplantation, 2021, 36 (3), pp.396-405. ⟨10.1093/ndt/gfz182⟩. ⟨hal-03498684⟩