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Int J Cardiol. 2016 Aug 15;217:16-27. doi: 10.1016/j.ijcard.2016.04.170. Epub 2016 May 3.

Sudden cardiac death and chronic kidney disease: From pathophysiology to treatment strategies.

Author information

1
Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy. Electronic address: dilulloluca69@gmail.com.
2
Division of Nephrology, S. Gerardo Hospital, Monza, Italy.
3
Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Rome, Italy.
4
Department of Nephrology and Dialysis, S. Anna Hospital, Como, Italy.
5
Department of Health Sciences, Renal Division, San Paolo Hospital, University of Milan, Italy.
6
Division of Nephrology, University of Naples "Federico II", Naples, Italy.
7
Department of Nephrology and Dialysis, Vito Fazzi Hospital, Lecce, Italy.
8
Consultant Nephrologist and Reader, Clinical Sub Dean, Renal and Transplantation Unit, St George's University, London, UK.
9
Department of Nephrology and Dialysis, S. Paolo Hospital, Civitavecchia, Italy.
10
International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy.

Abstract

Chronic kidney disease (CKD) patients demonstrate higher rates of cardiovascular mortality and morbidity; and increased incidence of sudden cardiac death (SCD) with declining kidney failure. Coronary artery disease (CAD) associated risk factors are the major determinants of SCD in the general population. However, current evidence suggests that in CKD patients, traditional cardiovascular risk factors may play a lesser role. Complex relationships between CKD-specific risk factors, structural heart disease, and ventricular arrhythmias (VA) contribute to the high risk of SCD. In dialysis patients, the occurrence of VA and SCD could be exacerbated by electrolyte shifts, divalent ion abnormalities, sympathetic overactivity, inflammation and iron toxicity. As outcomes in CKD patients after cardiac arrest are poor, primary and secondary prevention of SCD and cardiac arrest could reduce cardiovascular mortality in patients with CKD.

KEYWORDS:

CKD; Cardiac arrhythmias; Cardiovascular mortality; Sudden cardiac death

PMID:
27174593
DOI:
10.1016/j.ijcard.2016.04.170
[Indexed for MEDLINE]

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