The interplay between CKD, sudden cardiac death, and ventricular arrhythmias

Abstract

CKD patients face an increased risk of cardiovascular disease mortality, and the risk of sudden cardiac death (SCD) increases as kidney function declines. Risk factors for SCD are poorly understood and understudied among CKD patients. In the general population, coronary heart disease-associated risk factors are the most important determinants of SCD risk, but among CKD patients, there is evidence that these factors play a much smaller role. Complex relationships between CKD-specific risk factors, structural heart disease, and arrhythmic triggers contribute to the high risk of SCD and ventricular arrhythmias and modulate the effectiveness of available therapies. This review examines recent data on the epidemiology, pathophysiology, and mechanisms of SCD among CKD patients and examines current evidence regarding the use of pharmacologic and device-based therapies for management of SCD risk.

Keywords: Arrhythmias; CKD; Dialysis; Implantable cardioverter defibrillators; Sudden cardiac death.

Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Risk of sudden cardiac death by glomerular filtration rate among 19,440 subjects with significant coronary artery disease. (2)

Figure 2

Kaplan-Meier Survival Curves in ICD Recipients vs. Non-recipients According to eGFR. Unadjusted HR for mortality benefit of ICD: eGFR>=60 HR=0.53, 95% CI 0.42-0.67; eGFR