Expect the Unexpected: Sudden Cardiac Death in Dialysis Patients

[摘要] Over the past decade, a number of clinical trials addressing dialysis dose and frequency and cardiovascular risk have revealed that sudden unexpected deaths are a common occurrence among incident and prevalent dialysis patients (1,2). This high rate of out of hospital deaths has been confirmed in natural history studies, with an incidence as high as 25% over 5 years, and the rate has not substantially changed in the last decade regardless of dialysis modality (3,4). The biologic mechanisms and pathogenesis of sudden cardiac death among the dialysis population are almost certainly different than in the general population, as ESRD is an inflammatory state with regular fluctuations of electrolytes and fluid on an intermittent basis depending on dialysis modality. For the nephrology community to address prevention of sudden cardiac death, we need to answer some key questions to inform and guide our clinical decisions. How do we define sudden cardiac death? What are the potential mechanisms leading to arrhythmias and consequent sudden death among dialysis patients that may differ from the general population? What interventions may improve outcomes? Studying these questions will ultimately lead to preventive strategies to lower mortality risk among dialysis patients.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome