Incidence and Risk Factors of Sudden Cardiac Death in End-Stage Renal Disease Patients Undergoing Hemodialysis: A Retrospective Study.

Abstract

End-stage renal disease (ESRD) patients undergoing long-term hemodialysis (HD) are at increased risk of suffering from sudden cardiac death (SCD). ESRD patients on HD are distinctively vulnerable to SCD owing to periodic fluid and electrolyte imbalances, uremic environment, and foregoing cardiovascular injury. The present study was sought to evaluate the magnitude of incidence and risk factors of SCD in ESRD patients on HD in Pakistani population. A retrospective research study was undertaken at Tertiary Care Hospital in Karachi, Pakistan from May 2016 to April 2019. The study recruited 202 eligible ESRD patients undergoing long-term HD. Baseline characteristics of the study participants with and without sudden cardiac arrest (SCA) were recorded using self-reported questionnaires. Brief history was documented for comorbid such as diabetes mellitus (DM), hypertension (HTN), and family history of cardiac disease. SCA and SCD events were identified by reviewing medical records and death certificates. The study recruited 261 patients during the study duration; however, on the basis of exclusion criteria, 59 patients were ruled out. Out of 202 patients enrolled in the final analysis, 37 (18.3%) patients suffered from the episode of SCA. Of those 37, 18 (48.6%) of the subjects succumbed to death. ESRD patients who endured SCA were statistically older in comparison with their non-SCA counterparts (58.2 ± 11.4 years vs. 52.3 ± 9.3 years, P <0.001). When compared for comorbidities, HTN (67.6% vs. 64.8%, P = 0.001), DM (62.2% vs. 59.4%, P = 0.004), coronary artery disease (CAD) (45.9% vs. 41.8%, P = 0.001), and congestive heart failure (35.1% vs. 34.5%, P = 0.002) were significantly prevalent in ESRD cohort with SCA in contrast to non-SCA. We also found left ventricular hypertrophy (LVH) (62.2% vs. 48.5%, P <0.001), ventricular tachycardia (51.4% vs. 30.9%, P <0.001) and ventricular fibrillation/flutter (56.8% vs. 25.5%, P <0.001) to be statistically higher in ESRD patients on HD with SCA event. Through multivariate logistic regression analysis, we evidenced body mass index [odds ratio (OR) = 1.141, confidence interval [CI] 1.694-2.243, P = 0.004]; hypokalemia (OR = 1.247, CI 1.214-1.278, P <0.001); CAD (OR = 1.886, CI 1.469-2.342, P <0.001); LVH (OR 1.861, CI 1.392-1.953, P <0.001); ventricular tachycardia (OR = 1.253, CI 1.012-1.386, P <0.001); ventricular fibrillation/flutter (OR = 0.547, CI 0.518-0.773, P <0.001), and duration of dialysis (OR = 1.555, CI 1.427-1.852, P <0.001) significantly and independently associated with SCD in ESRD patients on HD. In conclusion, the prevalence of SCD among ESRD patients on HD with SCA episode is very high. CAD, ventricular tachyarrhythmias, and duration of dialysis were statistically significant among ESRD patients on HD with SCA in comparison with non-SCA and were independently associated with the prevalence of inpatient SCD among ESRD patients with SCA on HD.