Cardiac arrest and sudden death in dialysis units (original) (raw)

2001, Kidney International

Cardiac arrest and sudden death in dialysis units. mon cause of death, with nearly half of deaths attributed Background. For patients with end-stage renal disease and to myocardial infarction, cardiac arrest, or other cardiac their providers, dialysis unit-based cardiac arrest is the most causes [2]. Numerous studies have looked at predictors feared complication of hemodialysis. However, relatively little of cardiac mortality in maintenance hemodialysis pais known regarding its frequency or epidemiology, or whether tients. A history of ischemic heart disease, congestive a fraction of these events could be prevented. Methods. To explore clinical correlates of dialysis unit-based heart failure, left ventricular hypertrophy (LVH) and dyscardiac arrest, 400 reported arrests over a nine-month period function, peripheral vascular disease, hypertension or hyfrom October 1998 through June 1999 were reviewed in detail. potension, hypoalbuminemia, dyslipidemia, anemia, and Clinical characteristics of patients who suffered cardiac arrest inflammation (elevated C-reactive protein) have all been were compared with a nationally representative cohort of associated with increased cardiovascular mortality [3-9]. Ͼ77,000 hemodialysis patients dialyzed at Fresenius Medical Care North America-affiliated facilities. Using data from the U.S. Renal Data System Case Results. The cardiac arrest rate was 400 out of 5,744,708, Mix Adequacy Study, Bleyer, Russell, and Satko docucorresponding to a rate of 7 per 100,000 hemodialysis sessions. mented a significantly higher proportion of sudden Cardiac arrest was more frequent during Monday dialysis sesdeaths in hemodialysis patients on Monday and Tuesday sions than on other days of the week. Case patients were nearly twice as likely to have been dialyzed against a 0 or 1.0 mEq/L compared with other days of the week [10]. No other potassium dialysate on the day of cardiac arrest (17.1 vs. 8.8%). risk factors for sudden death were identified. The authors Patients who suffered a cardiac arrest were on average older postulated that the accumulation of electrolytes and flu-(66.3 Ϯ 12.9 vs. 60.2 Ϯ 15.4 years), more likely to have diabetes ids between dialysis sessions increased the susceptibility (61.8 vs. 46.8%), and more likely to use a catheter for vascular to arrhythmias, especially after a weekend respite from access (34.1 vs. 27.8%) than the general hemodialysis population. Sixteen percent of patients experienced a drop in systolic dialysis. No data were available on the timing of sudden pressure of 30 mm Hg or more prior to the arrest. Thirtydeath relative to the hemodialysis session. Presumably, seven percent of patients who suffered cardiac arrest had been the majority of sudden death cases occurred at home hospitalized within the past 30 days. Sixty percent of patients rather than during dialysis. died within 48 hours of the arrest, including 13% while in the dialysis unit. Relatively few studies have examined the epidemiol-Conclusions. Cardiac arrest is a relatively infrequent but ogy of in-dialysis unit cardiac arrest. Moreover, no prior devastating complication of hemodialysis. To reduce the risk investigation has had sufficient power to estimate its inof adverse cardiac events on hemodialysis, the dialysate precidence accurately or to identify patient-and hemodialyscription should be evaluated and modified on an ongoing sis-specific factors that might be associated with a higher basis, especially following hospitalization in high-risk patients. than baseline risk. We therefore undertook this study of cardiac arrest during hemodialysis using data obtained directly from dialysis units at the time of the event. We Hemodialysis patients have an age-adjusted mortality were most interested in identifying modifiable risk facrate that is 3.5 times higher than that of the general population [1]. Cardiovascular disease remains the most comtors so that some future events might be prevented.