Pathogenesis and Prevention of Sudden Cardiac Death in Hemodialysis Patients

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Aims: Hemodialysis patients experience an excess mortality, and recently sudden cardiac death (SCD) has been highlighted as common cause of death. However, the pathophysiology of SCD is not well understood. Beta blocker (BB) is proven as effective drugs for preventing SCD in patients with coronary artery disease and heart failure, however, the efficacy is not elucidated in this population. Methods: A total of 304 patients (200 men, age 64.7±12.8 years) who were treated with maintenance hemodialysis of more than 90 days duration from January 2005 to January 2007 were included and followed up with an end-point of sudden cardiac death or all cause death. Results: A total of 31 cases of SCD and 81 cases of non-SCD death occurred during median follow-up of 5.0 years. At the moment of SCD, the cardiac rhythm was lethal ventricular arrhythmia in 11 (35.5%), pulseless electrical activity or asystole in 15 (48.4%), and unknown in 5 (16.1%) patients. Seventy-six patients (25%) administrated BB, which use was significantly associated with a lower risk both of SCD and all-cause death even after adjusting for potential confounders [adjusted hazard ratio (HR), 0.25; 95% confidential interval (CI), 0.07–0.89; P=0.033, and HR, 0.37; CI, 0.21–0.65; P=0.001, respectively]. Conclusion: About half of SCD occurred with non-shockable rhythms in hemodialysis patients, and BB may prevent SCD in this population.
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