Journal of Nephrology

, Volume 27, Issue 1, pp 81–86

The association of ECG and echocardiographic abnormalities with sudden cardiac death in a dialysis patient cohort

  • Darren Green
  • James P. Ritchie
  • Nik Abidin
  • David I. New
  • Philip A. Kalra
Original Article

DOI: 10.1007/s40620-013-0013-4

Cite this article as:
Green, D., Ritchie, J.P., Abidin, N. et al. J Nephrol (2014) 27: 81. doi:10.1007/s40620-013-0013-4
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Abstract

Background

Cardiovascular mortality is greater in dialysis patients than the general population. More specifically, sudden cardiac death (SCD) accounts for 26% of dialysis patient deaths. However, SCD risk assessment tools used in the general population are not adequate for dialysis patients indicating that the hierarchy of pathopysiological factors appears to be different. The aim of this study was to use simple bedside tests to determine parameters independently predictive of cardiovascular mortality and SCD in dialysis patients.

Method and results

This was a sub-study of the Chronic Renal Insufficient Standards Implementations Study, a longitudinal cohort study of outcomes in CKD. ECG and echocardiographic abnormalities were assessed in a cross-section of prevalent dialysis patients. Patients were followed up until death or transplantation. Forward stepwise Cox regression then determined factors independently associated with all-cause, cardiovascular and SCD mortality. 323 patients were included (age 61.5 ± 14.6 years, 113 deaths, 66 cardiovascular deaths, 18 SCD). A number of factors were independently associated with all-cause mortality. These were age, time on dialysis, smoking, the difference between QRS and T-wave axes, resting heart rate, and pulmonary artery pressure (PAP) >35 mmHg. The only parameters predictive of SCD were elevated PAP (HR = 5.99, p = 0.05) and mitral regurgitation (HR = 6.71, p = 0.01).

Conclusion

That PAP is associated with SCD in dialysis patients demonstrates that the pathophysiological mechanism is likely to be different in these patients compared to the general population. Because of this, a population specific approach to risk stratification is advisable.

Keywords

Cardiovascular Dialysis ECG Echocardiography Sudden cardiac death 

Copyright information

© Italian Society of Nephrology 2013

Authors and Affiliations

  • Darren Green
    • 1
  • James P. Ritchie
    • 1
  • Nik Abidin
    • 2
  • David I. New
    • 2
  • Philip A. Kalra
    • 1
  1. 1.University of ManchesterManchesterUK
  2. 2.Salford Royal HospitalSalfordUK

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