Sudden Cardiac Death Risk for Patients on Dialysis

Sudden cardiac death (due to systemic inflammatory response and malnutrition) is emerging as the number one cause of death for patients on dialysis, according to a new study.

Researchers at Johns Hopkins University (JHU, Baltimore, MD, USA) conducted a 10-year study of a cohort of 1,041 end-stage renal disease (ESRD) patients on dialysis. During this period, 658 of this group died; the largest number of deaths, involving 146 patients, was the result of sudden cardiac death (SCD), in this study representing unexpected deaths that occurred outside of the hospital setting. The researchers then looked at previously recorded blood test results of 122 of these 146 SCD patients to search for a possible relationship between the deaths and levels of high-sensitivity C-reactive (hsCRP), interlukin-6 (IL-6)--which are markers for widespread blood vessel and organ inflammation--and albumin, low levels of which are associated with malnutrition.

The study results showed that patients with high levels of either hsCRP or IL-6 were twice as likely to die from SCD as those with low levels of these proteins were. Low albumin levels were associated with a 1.35 times increase in the risk of dying of SCD when compared with high levels. In addition, those with low levels of albumin and high levels of hsCRP were four times more likely to die of SCD than those with high levels and albumin and low levels of hsCRP were. The study was published in the November 2, 2008, issue of Kidney International.

"This is believed to be the first time anyone has taken a rigorous prospective look at why so many patients on dialysis die from sudden cardiac death, and the results could help doctors identify those at highest risk and potentially save lives,” said lead author Rulan Parekh, M.D., an associate professor in the department of nephrology at JHU. "When people think of heart attacks, they think of cholesterol and obesity; but these are risk factors for hardening of the arteries and are not directly linked to sudden heart death among patients on dialysis.”

ESRD, also known as chronic kidney failure (CKF) or chronic renal failure (CRF) is determined as stage 5 of chronic kidney disease (CKD), as measured by a glomerular filtration rate (GFR) of less than 15 mL/min/1.73 m², or by the need for permanent renal replacement therapy (RRT).

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Johns Hopkins University